HEALTHY CHILDREN 

S. JOSEPHINE BAKED 




Class. 
Book. 



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COPYRIGHT DEPOSIT. 



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HEALTHY CHILDREN 

A Volume 

Devoted to the Health 
of the Growing Child 

BY 

S. JOSEPHINE BAKER, M. D., D. P. H. 

Director, Bureau of Child Hygiene, Depart- 
ment of Health, New York City. 

Consultant in Child Hygiene, United States 
Public Health Service. 

Former President American Child Hygiene 
Association. 

Lecturer on Child Hygiene at Teachers Col- 
lege, Columbia University, New York 
University and Bellevue Hospital Medi- 
cal College. 

Member American Medical Association. 

Fellow New York Academy of Medicine. 




THE FEDERAL PUBLISHING COMPANY 

MINNEAPOLIS, MINNESOTA 
1920 



\ 



«£ 



Copyright 1920 

by the 

federal Publishing Co. 

Minneapolis 

Minn. 



FEB -2 132! 



u 

g)C!.A605651 



3 



TO 

MY FATHER 

AND 

MY MOTHER 

THIS BOOK ON 

HEALTHY CHILDREN 

IS LOVINGLY AND 

GRATEFULLY 

DEDICATED 



PREFACE 

For many years the health of the baby and 
the health of the child of school age have re- 
ceived attention from the public health author- 
ities, and particularly in our large cities there 
have been many opportunities for individual 
instruction of mothers in the care of little 
babies or older children. It is only recently, 
however, that the health of the child between 
two and six years has received any attention. 
This period of life has come to be known as the 
"preschool age." It is the time when the 
child is past babyhood, yet is not old enough 
to enter school. 

This book deals with the health problems 
of the preschool age child, but because during 
this age period the child is particularly sus- 
ceptible to many of the contagious diseases and 
to many of the more common infectious dis- 
eases, a large part of the book has been given 
up to a discussion of methods of controlling 
these diseases and caring for them at home. 
This consideration of illness, however, should 
not be allowed to outweigh the realization of 
the importance of prevention of disease and 
methods whereby children may be kept well. 
It is the purpose of the book to accentuate 
health, not disease, and to show the mother 
how she may give the child of preschool age 



PREFACE 



the same health care that is now so freely avail- 
able for the baby. It cannot be too strongly 
emphasized that this book is not intended to 
convey information which can be used in place 
of the expert care of a physician. In every 
case of illness a doctor should be summoned at 
the earliest possible moment and his advice 
and directions followed in detail. In order, 
however, to explain how health may be main- 
tained, it is necessary for the mother to know 
something of the early symptoms of the com- 
mon diseases, how they may be prevented, 
and the care that will shorten their course 
and give the doctor the most intelligent type 
of aid. 

As aids to child training and to lay the 
foundation for education, we have had a 
marked contribution made to the period of 
preschool life by Froebel, who gave us the idea 
of the kindergarten, and by Montessori, who 
has made practical many unique and valuable 
ideas in the training of the young child. In 
health matters, the child from two to six has 
received little, if any, attention and it is 
hoped that this book will help mothers to 
understand the importance of this period of 
life and give them the information to make 
healthy childhood continuous with healthy 
babyhood. 

VI 



PREFACE 



As far as possible, technical terms have 
been avoided, but occasionally it has been 
necessary to use them. A glossary will be 
found in the back of the book, containing ex- 
planations of the less understandable terms or 
words. Because health is affected by so many 
factors, it has been found necessary to repeat 
certain details under various headings. In 
studying any particular subject, every refer- 
ence to it should be read so that there may 
be more complete understanding. There is 
nothing difficult, nor need unusual methods be 
applied, in order to keep children well. Any 
effort, however slight, that is applied in that 
direction, will inevitably result in a finer and 
better developed race. 



S. JOSEPHINE BAKER. 



VI i 



CONTENTS 

Chapter I. Physical and Mental Development 
Height and weight; development of special senses: speech- 
stuttering or stammering; touch, taste, hearing, smell, sight. 
Muscular development: play and exercise. Influence of en- 
vironment Pages 1-28 

Chapter II. Personal Hygiene 
Location of the home; fresh air and ventilation; effect of bad 
air; heating and temperature. Clothing: outer clothing, under 
clothing, night clothing, shoes. Bathing: cold baths, warm baths. 
Sleep and quiet ; night terrors. Hygiene of the nose and throat ; 
adenoids, enlarged tonsils. Care of the teeth: temporary teeth; 
permanent teeth. Care of the eyes and ears Pages 29-73 

Chapter III. Training for Good Habits 
Regularity. Training the bladder; bed wetting. Training 
the bowels; constipation. Thumb-sucking. Nail-biting. Mastur- 
bation Pages 74-87 

Chapter IV. Foods and Feeding 
Food elements. Types of food. Value of certain foods at 
different ages. Foods to be avoided. General rules for feeding. 
Idiosyncrasies with regard to food. Sample diets. Diet in 
illness. The child who will not eat. Causes of lack of appetite, 
and results. Types of poor appetite. Management of loss of 
appetite Pages 88-112 

Chapter V. Malnutrition 
Causes, symptoms, care and treatment Pages 113-120 

Chapter VI. The Nervous Child 
Causes, symptoms, prevention and treatment. Chorea (St. 
Vitus Dance). Habit spasm Pages 121-137 

Chapter VII. Common Diseases of Childhood 
Causes, symptoms, prevention and treatment of coughs, colds* 
croup, enlarged glands, tonsillitis, earache, hiccoughs, headache, 
worms, hives (urticaria) Pages 1S8-16& 

IX 



CONTENTS 



Chapter VIII. Infectious and Contagious Diseases 
Early symptoms of infectious diseases. Symptoms, method of 
infection and home care of measles, German measles, scarlet 
fever, chickenpox, mumps, whooping cough, diphtheria, tuber- 
culosis. Contagious eye diseases: simple conjunctivitis, acute mu- 
copurulent conjunctivitis (pink eye). Contagious skin diseases: 
ringworms, scabies (itch), impetigo, pediculosis (head lice, body 
lice) Pages 163-194 

Chapter IX. Accidents and Injuries 
First aid; bruises, cuts, burns, sprains, strains, broken bones, 
nosebleed. Insect bites and stings. Foreign bodies in the 
throat, eyes or ears Pages 195-213 

Chapter X. The Children's Medicine Chest 

Type of medicine closet. Special rules. List of articles recom- 
mended. Description of simple remedies for home use 

Pages 214-225 

Glossary Pages 226-230 



x 



ILLUSTRATIONS 

Frontispiece Page 

Height and Weight Chart 5 

Pattern for Child's Rompers 39 

Child's Romper and Creeper 40 

Good Posture 51 

Mouth Breather, Showing Presence of Adenoids 64 

Undernourished Child 183 

Method of Applying Tourniquet 184 

Method of Applying Strips of Adhesive Plaster 
to bring Edges of Wound together 196 

Method of Bandaging Sprained Ankle 197 



XI 



HEALTHY CHILDREN 

CHAPTER I 

PHYSICAL AND MENTAL 
DEVELOPMENT 

The entire period of childhood is one of 
growth. There should be a normal, even de- 
velopment of the child's mentality and an 
equally regular development of the organs of 
the bod} 7 , the bones and the muscles. 

During the first year of life the needs of the 
baby are mainly physical. As the child grows 
older, its life becomes much more complex and 
its mental as well as its physical needs demand 
attention. The period under five years of age 
is one of very rapid growth. There is probably 
no other time in the life history of the in- 
dividual when both body and mind are so 
responsive to environment and impressions, 
and when so much can be done to build up 
good health as during the preschool age. 
During this time the child is both mentally and 
physically extremely sensitive to its surround- 
ings. It is keenly receptive to all impressions 
and suggestions. Everything that concerns its 
daily life leaves some impression, therefore it 
is of the utmost importance that during this 
time the child's surroundings, associates and 



HEALTHY CHILDREN 



training tend toward normal mental and 
physical development. 

While the needs of the child during this 
period may seem, and are to a great extent, 
rather diverse, it is a satisfaction to know 
that there is nothing that pertains to proper 
development of child life that is not within 
the reach of every family. It is particularly 
important during the preschool age that the 
child should live in decent and clean surround- 
ings, with as much fresh air as possible 
throughout the twenty-four hours. It is es- 
sential that the food be of the proper kind, 
and given at regular intervals, and that the 
clothing be suitable. The regular practice of 
personal hygiene is more important than at 
any other time of life, except during babyhood. 
Included in this is the care of all the organs 
and functions of the body. Sleep, rest, recrea- 
tion, proper bathing and hygiene of the eyes, 
ears, nose, throat and excretory organs, such 
as the skin, kidneys and bowels, are of im- 
portance. Not only are such surroundings 
and personal hygiene of the first importance 
at this time because of their immediate effect 
upon the child, but this is the period of life 
when health habits can be formed which will 
last as long as the child lives and which make 
all the difference in after life between poor 



PHYSICAL AND MENTAL DEVELOPMENT 3 

health or semi-invalidism and good health, and 
a life that is a satisfaction and a joy. 

Increase in Height and Weight i^ 

The best method we have of determining 
normal physical development is regular in- 
crease in height and weight. These bear a 
definite relation to each other. The child who 
shows a normal balance between its height 
and weight, and an increase in both these 
points in proper ratio, is a normally developed 
child, and, in the majority of instances, its 
nutrition is good. Some children, however, 
grow very rapidly as far as height is concerned 
but do not make a corresponding gain in 
weight. When a child weighs less than it 
should for its height, it is almost always an 
indication that there is something seriously 
wrong with its nutrition. The health of the 
child depends upon its proper nutrition. 
Nutrition, as we shall see later, is the result of 
proper hygienic surroundings and the right 
kind of food, which is properly digested and 
used by the body in promoting normal growth. 
It is important, therefore, to know in every 
stage of the child's development whether or 
not it is well nourished. The simplest and 
easiest way for the mother to determine this is 
in the relation between height and weight of 
the child at a given age. There are many 



HEALTHY CHILDREN 



other symptoms of undernourishment, which 
will be discussed later. The particular one 
which has to do with growth is the most 
important. 

In giving tables of heights and weights, it 
must be remembered that the average child 
is being considered. All tables of this kind are 
made up from the results of examinations of 
large numbers of children of various nationali- 
ties, living under conditions of both city and 
rural life. It is perfectly possible that a well 
nourished child may differ to some extent 
from the standard given as the average for a 
child of its age. It is safe to say, however, 
that this difference will not amount to more 
than ten per cent in either direction, therefore 
a child need not be considered undernourished 
or lacking in proper development unless it is 
at least ten per cent below the average weight 
in relation to its height and age. 

Children should have their height measured 
each six months and should be weighed once a 
month. It is wise to keep a chart of the 
child's weight. Such a chart may be made 
like the one illustrated on the next page. 
On this should be placed, in the appropriate 
column, a dot showing the child's weight on a 
given date. When the child is weighed the 
following month a dot should be placed in the 
next column and a line drawn between the two 



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MONTHS 

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SQNnOd NI JLH9I3M 



HEALTHY CHILDREN 



AVERAGE HEIGHTS AND WEIGHTS OF WHITE CHIL- 
DREN, BOYS AND GIRLS, UNDER SIX YEARS OF 
AGE, BY MONTHS, AS FOUND IN NEW YORK CITY. 



Age 



Under 1 month. 

1 month 

2 months. . . . 
3 
4 
5 
6 
7 
8 
9 

10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 



BOYS 



Average 
Height 
Inches 

21% 

22 

23% 

24 

24% 

25% 

26% 

26% 

27% 

27% 

28% 

28% 

28% 

29% 

29% 

30% 

30% 

30% 

31% 

31% 

31% 

31% 

32% 

32% 

33% 



Average 
Weight 
Pounds 

8% 
10 

11% 

13% 

14% 

15% 

16% 

17% 

18% 

19% 

19% 

20% 

20% 

21% 

21% 

22% 

22% 

23% 

23% 

24% 

24% 

25% 

25% 

26 

26% 



GIRLS 



Average 
Height 
Inches 

20% 

21% 

22% 

23% 

24% 

24% 

25% 

26% 

26% 

27 

27% 

27% 

28% 

28% 

29% 

29% 

29% 

30% 

30% 

31 

31% 

31% 

32 

32% 

32% 



Average 
Weight 
Pounds 

8% 
9% 
11 

12% 
13% 
14% 
15% 
16% 
17% 
17% 
18% 
19% 
19% 
20 

20% 
21% 
21% 
22% 
22% 
23 

23% 
24% 
24% 
24% 
25% 



PHYSICAL AND MENTAL DEVELOPMENT 



Age 



BOYS 



Average 
Height 
Inches 



Average 
Weight 
Pounds 



GIRLS 



Average 
Height 
Inches 



Average 
Weight 
Pounds 



25 months. 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 

51 

52 



33% 

33% 

34% 

34% 

34% 

34% 

34% 

35% 

35% 

35% 

35% 

36% 

36% 

36% 

36% 

37 

37% 

37% 

37% 

38% 

38% 

38% 

38% 

38% 

39 

39% 

39% 

39% 



26% 

27 

28 

28% 

28% 

28% 

28% 

29% 

30 

30% 

30% 

30% 

30% 

31% 

31% 

31% 

31% 

32% 

33% 

33% 

34 

34 

34% 

34% 

35% 

35% 

35% 

35% 



32% 

33% 

33% 

33V 9 

33% 

34 

34% 

34% 

35% 

35% 

35% 

35% 

35% 

36% 

36% 

36% 

36% 

37% 

37% 

37% 

38 

38 

38% 

38% 

38% 

39% 

39% 

39% 



25% 

25% 

26% 

26% 

26% 

26% 

28% 

28% 

28% 

29 

29% 

29% 

30% 

30% 

30% 

30% 

30% 

31% 

32 

32% 

32% 

32% 

32% 

32% 

33% 

34 

34% 

34% 



HEALTHY CHILDREN 







BOYS 


GIRLS 


Age 


Average 
Height 
Inches 


Average 
Weight 
Pounds 


Average 
Height 
Inches 


Average 
Weight 
Pounds 


53 moi 

54 ' 

55 ' 

56 ' 

57 4 

58 ' 

59 ' 

60 ' 
61 

62 4 

63 ' 

64 ' 

65 ' 

66 ' 

67 4 
68 

69 ' 

70 ' 


iths 


39% 
39% 
40% 

40% 

40% 

40% 

40% 

41 

41% 

41% 

41% 

41% 

41% 

42% 

42% 

42% 

42% 

43% 


35% 

35% 

36% 

37% 

38% 

38% 

38% 

38% 

38% 

38% 

38% 

39 

39% 

39% 

39% 

40 

40% 

41% 


39% 
39% 
39% 
40 

40% 

40% 

40% 

40% 

40% 

41 

41% 

41% 

41% 

42 

42 

42% 

42% 

42% 


34% 

34% 

34% 

35% 

36% 

36% 

36% 

36% 

36% 

37 

37% 

37% 

37% 

38% 

39% 

39% 

39% 

40% 



PHYSICAL AND MENTAL DEVELOPMENT 9 

dots. A comparison can then be made with 
the tables shown on pages 6, 7 and 8 showing 
the height and weight of average children. 
As the weighing progresses, it may be seen 
at a glance whether there is a regular in- 
crease in weight. The weight at any one 
particular time is not the most important 
point to notice. It is essential, however, that 
there should be a regular and definite gain, and 
if the weight is stationary for more than two 
months, or if a loss in weight is shown at any 
time, immediate attention should be paid to 
readjustment of the child's life to more nearly 
meet its needs. It will be noted that the in- 
crease in height and weight is not so rapid 
after the first year, An easy way to remem- 
ber the right weight for a given age is that the 
average gain amounts to about five pounds a 
year from the first to the eleventh years. After 
that a child will gain an average of ten pounds 
a year until the time for growth is over. 

The gain in height is not so regular. At 
the end of the first year the baby should 
measure about twenty-eight inches. Each 
year thereafter, until the fifth, there should be 
an average gain of four inches in height. 
From the fifth to the tenth years the gain 
Varies from two to three inches. The table 
will show this increase more in detail. 



/ 



10 HEALTHY CHILDREN 

DEVELOPMENT OF SPECIAL SENSES 

While the term ' 'growth' ' commonly refers 
to increase in size, the development of the 
child includes its increase in mental power, 
and increased activity and keenness of the 
various functions. Some children show an 
abnormally rapid development. There are 
many instances of so-called ' 'infant prodigies" 
where children learn to read and write and 
even to grasp difficult mental problems at an 
extraordinarily early age. Such children are 
the exception, however, not the rule. Unless 
the child shows unusual mental capacity and 
the parents are able to control its development 
with the utmost wisdom, it is better to con- 
sider the period from one to five years of age 
a time when the foundation is laid for good 
health and good mental development, rather 
than a time when the child is forced into 
activity which will interfere with its oppor- 
tunity for play, recreation, amusement and 
for the normal training and development which 
are the right of every child. There is no 
absolute rule to show the exact progress and 
development of the special senses in children 
from one to five years of age. Because of the 
great variation, we can speak of the subject 
only in a general way. 



PHYSICAL AND MENTAL DEVELOPMENT 11 

Speech 

Ordinarily, at the end of one year, the baby 
has learned to say a few words, and by the 
time it is eighteen months old these words may 
be put together into short sentences. The 
little child, as soon as it learns to talk, almost 
always uses its first words to ask questions. 
The curiosity of young children is insatiable. 
This is not a senseless curiosity, but a per- 
fectly normal one, and speech offers the child 
an opportunity to satisfy its thirst for knowl- 
edge. Speech is used also as a means of ex- 
pressing the child's own ideas, and the con- 
stant use of speech for these two purposes 
tends to develop it as a mode of expression 
much more rapidly than is the case in the 
development of the other senses. 

It is necessary to urge some children to talk; 
others talk incessantly, without urging. The 
child who must be urged to talk may be simply 
indifferent, but there is always the possibility 
of a mental defect when speech has been 
markedly retarded or is completely absent 
when the child is two years of age. Under such 
circumstances, only a thorough physical and 
mental examination will determine whether 
or not the child is simply backward or indif- 
ferent, or whether there is some physical defect 
which interferes with speech, or, possibly, some 



12 HEALTHY CHILDREN 

mental defect. In a large number of in- 
stances where mental defect is the cause of in- 
ability to speak, there is a corresponding deaf- 
ness, and the child's inattention and apparent 
inability to hear may often be the first signs 
noted. Careful attention should be paid to this 
matter, because if deafness is present in addi- 
tion to inability to speak, deafmutism should 
receive early attention at the hands of a spe- 
cialist. 

Stuttering or Stammering 

Stuttering, stammering or distorted speech 
may be the result of some physical defect or a 
marked nervous condition, or it may be the re- 
sult of habit. Occasionally, a child's tongue will 
be bound down to the floor of the mouth by a 
tiny fold of mucous membrane, and this inabil- 
ity to move the tongue freely leads to distort- 
ed speech and difficulty in pronouncing certain 
words. Such children have a tendency to lisp. 
Letters like "s" cannot be pronounced clearly, 
and there is a blurring over of many word 
sounds. The treatment is simple. Any physi- 
cian can make a small cut in the mucous mem- 
brane, releasing the tongue so that it is freely 
movable. The operation is not at all dangerous. 

Stuttering and stammering sometimes start 
as a purely nervous habit, because the child 
has been unduly urged to talk or is of an 



PHYSICAL AND MENTAL DEVELOPMENT 13 

extremely nervous disposition. As soon as an 
effort is made to say anything, there is loss of 
speech control, usually the result of some 
emotional disturbance. Stammering or stut- 
tering increases the more the child tries to ex- 
press itself. A great deal may be done in 
early life to correct this condition by teaching 
the child to speak slowly and to accent dis- 
tinctly every syllable of a word. Every effort 
should be made to overcome the emotional 
excitement and the nervousness. Such children 
should never be forced into new experiences 
that may be mentally disturbing. They should 
be brought into contact with other children 
for normal play, but great tact must be used 
in handling them at all times. Particular care 
should be taken to see that no one makes fun 
of their infirmity. In a great number of cases 
constant attention to slow speech and calming 
all nervousness will cure stuttering and stam- 
mering. However, if the habit becomes estab- 
lished and continues until the child is five 
years old, it is probable that special treatment 
will be necessary, and this can be carried on 
only by someone who has made a special 
study of the subject. 

Touch, Taste, Hearing, Smell 

All of these functions develop first in baby- 
hood, but are not keen until the child is past 



14 HEALTHY CHILDREN 

eighteen months of age. Up to that time 
they have a very limited relation to the child's 
life, but after the baby passes the age of 
eighteen months, if it is normally developed, 
it begins to make conscious effort to use these 
special senses in order to widen its understand- 
ing of its environment. 

The function of touch in young children is 
peculiarly acute. Madame Montessori has 
taken advantage of this idea in her method of 
training children, and it has been found pos- 
sible to develop this sense in very young 
children to a remarkable and hitherto un- 
thought-of degree. Up to the time a child is 
five years of age, it is possible to cultivate the 
delicate sense of touch so that it may become 
an important aid throughout life. It is easily 
blunted, if neglected. The child should be 
encouraged to tell the shape of various articles 
by feeling them rather than by looking at 
them, to tell the texture of materials by the 
sense of touch, to distinguish between soft and 
hard substances or between smooth and rough 
materials, to determine the texture of plants, 
trees and growing things, as well as the texture 
and character of all familiar, material sur- 
roundings. This opens up a wonderful method 
of training children to be observant, interested 
and of delicate comprehension. Children who 
have their sense of touch developed to this 



PHYSICAL AND MENTAL DEVELOPMENT 15 

extent have acquired something that will add 
immeasurably to their future pleasure in life. 

Taste and smell are not acutely developed 
during early child life. Children have marked 
prejudices with regard to certain articles of 
food, and these prejudices frequently relate to 
taste. Thus rnilk, which may be very much 
disliked as a drink, will often be taken when 
prepared in the form of soups, custards or ice 
cream. Eggs, when distasteful if eaten alone, 
will be eaten if disguised as part of some 
pudding or custard. On the whole, however, 
the sense of taste is not particularly keen and 
children will put into their mouths things which 
would be considered distasteful to an adult 
with a normally developed sense of taste. 
Little children do not mind eating mud, clay 
or even more repulsive things. Fine taste is 
largely the result of cultivation in later years. 

The sense of smell in young children is not 
well developed. They rarely are sensitive to 
disagreeable odors or appreciative of delight- 
ful ones. If the sense of smell is totally 
lacking, that is, if the child is unable to dis- 
tinguish that the rose has perfume or that 
anything is distinctly repulsive or has a bad 
smell, it is probable that there is some marked 
nasal catarrh or nasal occlusion, due to adenoid 
growths. 



16 HEALTHY CHILDREN 

Sight 

Early development of sight has mainly to 
do with distinction between light and dark- 
ness, recognition of people who are well known, 
such as father, mother or nurse, or distinguish- 
ing bright colored objects. Red is probably 
the first color that is noticed by the baby, and 
bright colors have an unusual attraction 
throughout childhood. It is not until the 
baby is about two years old that it begins to 
appreciate objects in their proper relation to 
each other. 

Muscular Development 

The condition of the child's muscles is large- 
ly dependent upon its nutrition. Muscular 
tissue develops more rapidly when it is used, 
and the constant restless activity of the normal 
child usually results in firm, hard and adequate 
muscles. Children who are not well nourished 
suffer from extreme bodily fatigue and their 
muscles are apt to be flabby and soft, but in a 
child who is living under the right conditions 
and who is well nourished, the muscular tissue 
can be felt all over the body, well rounded and 
firm, and the child will be active without 
fatigue. 

During the first two or three years of life 
there is little conscious control of the muscular 



PHYSICAL AND MENTAL DEVELOPMENT 17 

development. Learning to walk is probably 
the first expression of conscious muscular con- 
trol and after the child finds that it can control 
the movement of its legs and feet, it begins, 
usually by itself, to learn to control the move- 
ments of other parts of the body. Little 
children also have the power of complete re- 
laxation. This is shown in the way in which 
they fall. A child running along the street 
will stumble and fall at full length, only to 
jump up again and run on as strongly as 
before. In all probability, such a fall would 
seriously injure an adult, and certainly there 
would be a nervous shock. This ability to 
relax the muscles completely becomes less as 
the child grows older and becomes more tense 
and more conscious of its muscular movements. 
Every effort should be made to allow free 
muscular development. Loose clothing of 
every kind, including loose shoes, utter free- 
dom of motion of the arms and legs, provision 
of opportunities for play which involve use of 
the muscles of the body, are all essential. Left 
alone, children will develop their muscular 
tissue without supervision and there is little, 
if any, danger of muscular strain in a healthy 
child who lives the average normal life, with 
regular hours of sleep and play, and the 
proper kind of food. Muscular exercise tends 
to make all organs of the body function in a 



18 HEALTHY CHILDREN 

proper manner. The sedentary child, or one 
who is brought up much indoors, suffers 
readily from constipation, indigestion and 
similar troubles. Often the only thing that is 
necessary to correct this condition is to pro- 
vide opportunity for free outdoor play. 

Play and Exercise 

The normal child has an inherent instinct 
for play. One of the pathetic effects of city 
life is the provision that it has been necessary 
to make for supervision of play for young 
children. Ordinarily there are only two points 
about which we need concern ourselves in 
this connection: the first is that the children 
have a place to play where they can do so with 
safety and the other is that their play is not 
vicious. They may safely be trusted to de- 
velop for themselves the type of play which 
most interests and amuses them, and that 
type is usually the one which does them most 
good. Outdoor games should be encouraged. 
Except in very stormy or extremely cold 
weather, the child of preschool age should be 
out-of-doors the greater part of the twenty- 
four hours. Games of childhood are tradi- 
tional. They pass from one generation to the 
next as regularly and inevitably as life itself. 
No one knows how the old nursery games are 
passed down from child to child, but, generally 



PHYSICAL AND MENTAL DEVELOPMENT 19 

speaking, the games of the children of today 
are not at all unlike those of their parents, 
their grandparents or even back into the pre- 
ceding generations. 

Except in unusual instances, children do 
not have to be taught any special games, but 
one marked characteristic of very early child- 
hood should always be borne in mind. Lack 
of understanding of this characteristic is more 
common among the well-to-do than among 
those less blest with worldly goods. Little 
children do not care for expensive mechanical 
toys. They have a creative instinct and want 
to make their own games and their own play. 
The imagination of the little child has no 
limits. An old packing box or piece of cloth 
that can be made to serve as a tent holds 
undreamed-of possibilities of happiness. Nine- 
tenths of the normal games of early childhood 
exist only in the imagination of the child, and 
if any aid at all is desirable to help children 
play, it is the kind that cultivates the imagina- 
tion rather than retards it by furnishing toys 
which are warranted to go by themselves and 
which do not need any help from the child. 
A normal child can have infinitely more fun 
out of an old box which is dragged along the 
street by a string to serve as a doll carriage 
than it can get out of the most perfect mechan- 
ical electrically-propelled train that was ever 



20 HEALTHY CHILDREN 

made. Children as well as adults grow by 
expression and in their play they have the 
opportunity to express themselves quite natur- 
ally, without the restrictions which bear so 
heavily upon them when they are closely 
associated with the world of adults, therefore 
toys for children should be of the simplest. 
Such things as heaps of sand where they may 
dig to their heart's content, boxes or blocks 
which cannot be injured but which may be 
used by the children to form any object which 
their imagination desires, and, above all, wide 
and unrestricted play space, are all that are 
needed to make the average children healthy 
and happy. Initiative and the power of ex- 
pression are marvellously stimulated by this 
kind of play and are almost always retarded, 
if not killed altogether, by manufactured play 
and toys that have had done for them all that 
the child would wish to do for itself. 

During the preschool age there should be no 
formal children's parties. If birthdays must 
be observed, it should be in the simplest man- 
ner possible, preferably with outdoor play and 
some very simple refreshments, such as ice 
cream or custard, in addition to the birthday 
cake. It is far better, however, for children 
of this age not to have the stimulation that 
comes from forced play and the emotional 
excitement that almost always attends parties. 



PHYSICAL AND MENTAL DEVELOPMENT 21 

There is also the possibility of the spread of 
infection. It is a well-known fact that con- 
tagious diseases always increase after the 
holiday periods. The gathering together of 
children in parties and entertainments is one 
of the best known methods of spreading in- 
fection. As little children are so particularly 
susceptible to contagion, children's parties 
should be extremely rare. The emotional ex- 
citement is also very bad for young children. 
Up to the age of five years the emotions are 
not definitely under control and many children 
have had the basis of nervous disorders in 
later life firmly established as a result of the 
excitement and artificial life connected with 
being entertained frequently in early child- 
hood. 

Another word of warning should be uttered 
against having children "show off." The pre- 
cocious child is always a bore to everyone but 
its parents. The pleasure that normal children 
can give is delightful, but the precocious child 
has not a fair chance, because its parents put 
it in a position where it is unwelcome to 
others and where it readily acquires that 
type of egotism which is of all attributes the 
most distressing that can be found in child- 
hood. Little children should never be urged 
to recite, to dance or "show off" in any way 
before others. The nervous excitement is 



22 HEALTHY CHILDREN 

extremely bad for the child and certainly 
nothing can be worse than the development of 
this egotism. 

Opportunities for proper play accentuate the 
great advantages the country child or the child 
of sensible parents has over children in the city 
and children who are the victims of over-in- 
dulgence and over-care. Old clothes that can- 
not be hurt, torn stockings and worn out 
shoes, bruises and bumps, and the oppor- 
tunity to get throughly dirty with mud pies 
and sand piles, all belong to the right of 
childhood. Cleanliness and order can and 
should be insisted upon, in their proper place, 
but for the greater part of the day the child 
should be looked upon as a little, growing 
animal and allowed free expression of its play 
instinct. 

INFLUENCE OF ENVIRONMENT 

Environment consists of all the external 
surroundings and conditions that affect the 
development of the person and increase, modi- 
fy or change the inherited qualities of the 
individual. It is reassuring to know that, 
although we may not be able to choose the 
type of inheritance we would like, and may 
have to take that which does not accord with 
our desires, yet we can to a very large extent 
control our environment, and we can choose 



PHYSICAL AND MENTAL DEVELOPMENT 23 

and maintain a proper environment for our 
children. The time when environment has 
the greatest effect upon the development of 
the individual is during early life. In human 
beings, development of the young covers a 
far greater period of time than it does in the 
life history of any other species of animal, 
consequently fathers and mothers have a very 
great responsibility in seeing that, during the 
entire period of development, their children 
have the right surroundings and the right in- 
fluences. 

During the prenatal period and in infancy, 
the baby's environment is its mother and her 
relation to the child is mainly one of protect- 
ing it from harm and supplying it with nourish- 
ment. It is extraordinary, however, to re- 
alize how early in life the child's mind begins 
to develop and to receive impressions from its 
surroundings. The whole process of education 
is largely dependent upon taking advantage 
of our experiences in the past and modifying 
our behavior in the future to accord with 
them. The formation of habits in early in- 
fancy is so important a matter that the 
mother and father are entirely responsible for 
determining whether the baby's habits shall 
be good or bad. Throughout the entire life 
of the child the right kind of environment or 
surroundings is of the utmost importance. 



24 HEALTHY CHILDREN 

When they are proper, the child will develop 
into a person with good habits and fine char- 
acter, and in this way any desirable inherited 
traits may be intensified. On the other hand, 
any inherited traits of undesirable type will 
become more pronounced if they are not 
corrected by proper training and proper en- 
vironment. 

Proper training and environment are those 
influences which develop in a child the habits 
of self-reliance, clear thinking, receptive mind, 
truthfulness and independent, honest action. 
Many books have been written on the subject 
of proper child training. It seems to be the 
consensus of opinion that training for good 
habits must begin at the time of birth. Parents 
have no right to impose arbitrary standards 
upon their children after the latter have reach- 
ed a reasoning age, until the reason for the 
action has been explained to them. It is far 
better and wiser to make instructions to 
children consist of a series of positive state- 
ments, such as "Do this" and "Do that" 
rather than to have the child's life made up 
of a series of "Don'ts" which are arbitrary in 
character, and which are never accompanied 
by any explanation. More and more, as we 
study the psychology of the child, we come to 
the conclusion that most of the training of 
children should begin with the previous train- 



PHYSICAL AND MENTAL DEVELOPMENT 25 

ing of their parents. Often it is the faults of 
the parents, reflected in their management of 
the children, which cause the formation of 
many bad habits, and create the antagonistic 
spirit which leads to disregard of the rights of 
others and bad character formation. 

It is well to remember that we cannot 
bequeath to our children the education and 
training we have acquired, except in so far as 
we may give them the benefit of it by making 
it part of their environment. Our whole 
civilization is made up of the experience of 
former generations which has been handed 
down through ages. We inherit culture and 
the various things that make up what we call 
i 'civilization' ' in the same way that we in- 
herit property, but such things are ours only 
so far as we avail ourselves of them and 
reflect them in our conduct. Each generation 
can use the best that the preceding generations 
have had to offer and through these environ- 
mental influences develop its own individuality 
in the best possible manner. 

The kind of family environment that is best 
for the child does not depend upon money, 
social prominence or material luxury. History 
is full of examples of children born of the most 
obscure parents who have, in spite of their 
handicaps — I would rather say because of 
them — risen to positions of acknowledged em- 



26 HEALTHY CHILDREN 

inence. This does not mean that an environ- 
ment of hardship is always necessary in order 
to develop genius. It is not probable that 
anyone becomes creative because of environ- 
ment. It is necessary that he must have 
ability, as a matter of direct inheritance, but 
it is always possible that the ability might 
never have been developed if the child had not 
been brought up in the right environment. 
What are called great advantages for children 
are sometimes disadvantages. It is possible 
for an environment to be "too good." It is 
quite conceivable that a child may have a diet 
that is of the most luxurious type, yet it may 
be extremely bad for its health. On the other 
hand, a diet of the utmost simplicity and 
economy may be planned that will furnish all 
the necessary elements of food to promote the 
best type of health and growth. The child 
who is never made to mind, who is allowed to 
follow its own will, rarely has its character 
developed in the right direction. It is true 
only too often that children of wealthy 
parents have all ambition stifled and all initia- 
tive destroyed because they have no stimulus 
to be anything other than they are. On the 
other hand, a certain amount of hardship in 
life, coupled with what seem to be disad- 
vantages and difficulties, often proves a 
stimulus to the development of proper char- 



PHYSICAL AND MENTAL DEVELOPMENT 27 

acter. This does not mean that poverty is 
necessarily good in itself, or that wealth is 
necessarily bad. It does mean, however, that 
children should not be brought up in idleness 
or luxury, but should have their daily tasks, 
should be made to feel responsibility for their 
attitude toward life, should have a relation- 
ship of understanding with their parents, and 
live in an atmosphere where traits of honesty, 
decency and true culture are common. If 
these traits occur in a family there need be no 
apprehension, but rather a feeling of having 
bequeathed a fine heritage and a still finer 
environment to the child. Often it is better 
for the child if there are minor hardships to 
be overcome and it is wise, even from early 
babyhood, for the child to be surrounded by 
an environment which must be met with 
initiative and a certain amount of exertion. 
In individual instances, the poor boy or girl 
from the country who has had to work hard 
to cope with all the difficulties of frontier or 
country life may not outstrip the wealthy boy 
who has been brought up in the city, but, 
generally speaking, that kind of early environ- 
ment stimulates self-reliance and the ability 
to conquer difficult circumstances. Moral and 
mental development, including ideals, moral- 
ity, responsibility, habits and thoughts, as 
well as the type of religion we adhere to, and 



28 HEALTHY CHILDREN 

the political party to which we belong, are 
almost entirely the results of environment in 
the early years of life. The great Cardinal 
Newman said: "Give me a child until he is 
seven years old and I care not who trains him 
afterwards." Whatever happens to us later in 
life, of one thing we may be sure : that is, that 
every incident of our environment and train- 
ing, from the time we were conceived until we 
pass out of childhood, influences our future 
lives. 



CHAPTER II 

PERSONAL HYGIENE 

Personal hygiene includes the proper care 
of the body and its organs so that they may 
function and develop in a normal manner. 
Proper personal hygiene is dependent to a 
great extent upon the right kind of surround- 
ings, and the normal development of the 
young child will result not only from the care 
that is given to the body, but also from the 
opportunity the child has of living in a clean, 
decent and wholesome environment. 

Location of the Home 

The location and general character of the 
house where the child lives depends upon so 
many factors that often it is difficult to pro- 
vide the growing child with exactly the right 
housing environment. Whenever there is a 
choice, however, between a crowded city and 
the more open country, or between a roomy 
house and a limited apartment, the country 
and the house should always be chosen. 

There are many advantages in city life for 
children, and statistics have proven only too 
frequently that country children are not 
better developed nor more free from disease 
or physical defects than city children. This 
is because, as a rule, city children have re- 

29 



30 HEALTHY CHILDREN 

ceived more attention not only from their 
parents but from the community in order to 
offset the evils of city life, whereas in the 
country it has been thought that the fresh air 
and opportunities for outdoor recreation com- 
pensated for many defects in feeding, regular 
hours and proper attention to the care of the 
skin and the right kind of clothing. These 
statements are generalities, of course, because 
individual cases can be cited with the object 
of proving that country life is the normal one 
for children. Certainly, no one can seriously 
question this statement. The physical restric- 
tions of city life are not only burdensome for 
parents, but they are distinctly harmful for 
children. Nevertheless, so much depends upon 
the child's immediate surroundings and en- 
vironment that there is no reason why children 
in cities should not have perfect health. This 
may require attention and care, and a great 
deal of effort may be necessary to give to the 
city child the things that come quite naturally 
to the country child, but, all things considered, 
the country child has the greatest natural 
advantages. 

Growing children should always have the 
opportunity for plenty of play space. As a 
general thing, this is possible only when the 
family occupies a detached house with a yard 
or even a greater amount of ground. In ad- 



PERSON AL HYGIENE 31 

dition, the house affords greater opportunities 
for proper ventilation and plenty of sunshine 
in the living rooms. The noise, dirt and odors 
of the city streets are absent. Pure, clean milk 
and green vegetables are, or should be, fresher 
and more easily obtainable. With the same 
amount of care and attention given to the 
child's life, there is little doubt that the 
country can be shown to have enormous ad- 
vantages from the point of view of health. 

Fresh Air and Ventilation 

Growing children need fresh air in abun- 
dance. It is absolutely essential for their 
health. By fresh air is meant not an outing 
of an hour or so each day, but outdoor life as 
completely as possible for the entire twenty - 
four hours. Certainly, the child of preschool 
age should be able to have most of its recrea- 
tion in the fresh air except in extremely cold 
or very stormy weather. In all country 
climates and where it is possible to have a 
sleeping porch, the child should be trained to 
sleep outdoors from the time it is a few weeks 
old. A porch, preferably one that is above the 
ground floor, can easily be changed to a sleep- 
ing porch. It should be built up on two sides 
and open on the other two. A roof or awning 
over the top is advised. The child can be 
undressed indoors, and, in cold weather, may 



32 HEALTHY CHILDREN 

wear a warm wrapper while going out to bed 
on the sleeping porch. Sleeping bags made of 
a steamer rug or heavy woolen blanket will 
be found useful. These are made by folding 
the blanket once over and sewing it across one 
end and partly up one side, leaving an opening 
at the upper part of the side and across the 
top. Snap fasteners should be sewed on this 
opening, and, after the child has been placed 
in the bag, the latter can be brought together 
over the shoulders and down the side. Small 
openings may be made, if desired, so that the 
hands may be put through. In very cold 
weather a woolen cap or bonnet is essential, 
and some warm type of underclothing, such as 
flannel petticoats or nightdrawers, with knit- 
ted socks, should be added. The face is left 
uncovered but the other parts of the body 
should be kept warm and the amount of bed 
covering used should be just sufficient for this 
purpose. 

If, for any reason, the child cannot sleep 
out-of-doors, the bedroom should be well 
ventilated. The windows should be open all 
night. In order to avoid a draft, a window 
board or window deflector may be used. This 
may be made at home, and the purpose of 
its use is to allow free ventilation without 
drafts. With the window board, the air comes 
in between the upper and lower sashes; with 



PERSONAL HYGIENE 33 

the window deflector, the air comes directly 
into the room, but is deflected so that there is 
no direct air current. A good form of ventila- 
tion for the sleeping room, particularly in 
climates where there are high winds, is to 
take out one of the upper panes of glass and 
cover the opening with unbleached muslin. This 
will give excellent ventilation without draft 
or marked lowering of the indoor temperature. 
There should be plenty of bed clothing, and 
with young children it is permissible to use 
hot water bottles if there is a tendency for the 
feet to be cold. The bed should be placed so 
that there is no direct current of air blowing 
across it. If necessary, screens should be used. 

Effect of Bad Air 

The human body is usually quite adaptable 
to its surroundings and people who habitually 
live in badly ventilated rooms become so 
accustomed to the close air that they do not 
seem to notice it, while people coming into the 
same room from outdoors will be almost 
stifled. The bad effect of such vitiated at- 
mosphere is particularly marked in children. 
Children kept indoors in poorly ventilated 
rooms are almost always pale, underdeveloped 
and anemic. Usually they suffer from mal- 
nutrition, have a poor appetite and are apt 
to have indigestion. They are almost always 



34 HEALTHY CHILDREN 

constipated. Marked irritability and lack of 
concentration, with restless sleep, are all in- 
dications that the child is not getting enough 
air. It is probable that sleeping in badly 
ventilated rooms promotes the growth of 
adenoids and enlarged tonsils. Certainly, there 
are few physical defects or varieties of ill- 
health in children that cannot be caused by 
lack of fresh air. 

Heating and Temperature 

The type of heating and the temperature of 
rooms are closely associated with ventilation. 
In the construction of new houses or where 
there is any choice, the best system of house 
heating is steam or hot water. Open fire- 
places are excellent, particularly for sleeping 
rooms, as they not only provide heat, but 
serve as a means of ventilation. The ordinary 
closed stove is probably the worst type of 
heating we have. The oxygen in the air is 
used up rapidly and no method is provided in 
the heating apparatus for renewing the air. 
Certain forms of jacketed stoves, however, 
aid in proper ventilation. Heating by means 
of gas stoves or oil stoves is particularly bad, 
especially in bedrooms. They should be used 
only where the ventilation is free and adr 
equate, and then only for short periods of 
time. . The temperature of the house during 



PERSONAL HYGIENE 35 

the day should not at any time be over seventy 
degrees, preferably sixty-five. The sleeping 
rooms should range from fifty to sixty degrees. 
In very cold weather the temperature may 
be lower than this, provided the bed clothing 
is adequate. 

Clothing 

The clothing of children as well as adults is 
worn for several purposes: first and primarily, 
for protection and warmth; second, for the 
sake of appearances, for modesty and to ex- 
press attractiveness or beauty. There are 
other minor reasons for wearing clothes, which 
are dependent upon the kind of clothes that 
are worn, therefore, in dressing children, there 
should be some knowledge on the part of the 
mother of the properties and principles of 
different clothing. 

Notwithstanding the impression to the con- 
trary, the majority of children are clothed too 
warmly. Within the past five years there has 
been an increasing tendency on the part of 
intelligent parents to use washable materials 
for dresses for girls and suits for younger boys 
throughout the entire year, providing the 
necessary outer wraps to meet the needs of 
the outdoor temperature. It is not too much 
to say that far more harm is done to children's 
health by too much clothing than by too 



36 HEALTHY CHILDREN 

little. The body becomes overheated, with 
resultant tendency toward taking cold and 
lowering the general vitality. The proper way 
to dress children is for the temperature of the 
day, not for the time of year. Generally 
speaking, with our houses at a temperature 
of sixty-five to seventy degrees during the 
winter, the type of clothing worn indoors by 
the child at that time should be no heavier 
than when the outdoor temperature registers 
the same figure. The outdoor clothing in 
winter can be as heavy as desired, and should 
afford complete protection to the child's body, 
head, hands and feet. In hot weather, clothes 
should be light and few in number. Except 
for the mere purpose of covering the body, 
clothing is a burden to children when the 
temperature goes above eighty degrees. Stock- 
ings, hats and caps are not necessary during 
the hot weather, except that some light form 
of straw hat may be worn as a protection from 
the sun. In cold weather, the child's legs 
should be covered. The fashion of having 
growing children wear socks throughout the 
winter, leaving the greater part of the legs and 
knees exposed, is an extremely pernicious one. 
The blood vessels supplying the legs lie very 
close to the surface at the knees and exposure 
of this delicate part of the body may easily 
result in lowering the entire body temperature. 



PERSONAL HYGIENE 37 

The practice cannot be too strongly con- 
demned. 

The two most important principles of cloth- 
ing children are, first, that there shall be com- 
plete freedom of action for the body, and no 
constriction of any of its parts; and, second, 
that the kind of clothing should have the 
property of protecting the body from too 
great a loss of heat, and that it should be of a 
type that will absorb moisture from the body 
surfaces and prevent too rapid evaporation of 
the secretions of the skin. 

The young and growing child should not be 
restricted in any way by its clothing. Up to 
the age of six years it is possible to dress boys 
and girls almost exactly the same way. All 
clothing should be suspended from the should- 
ers, never from the waist line. The best type 
of garters are those that have straps from the 
shoulders. Round garters should never be 
used. 

The main function of clothing is to keep the 
body warm and protect it, and it does this by 
virtue of its power to retain or allow the 
evaporation of the natural body heat. Warmth 
of clothing does not depend upon weight, but 
upon the way in which it is woven. Air is a 
poor conductor and a thin layer of air next to 
the body acts as a protection against the loss 
of body heat. Loosely woven goods which 



3S HEALTHY CHILDREN 

may retain air in its meshes is warmer than 
closely woven fabrics. Woolen goods are 
usually loose in texture, therefore wool is one 
of the warmest fabrics to be used for clothing 
in cold weather. Wool has certain undesirable 
qualities, however. When worn next to the 
skin it may cause marked irritation. It also 
has a tendency to shrink when washed, and 
thereby loses its porous qualities. Woolen 
undergarments are not advised for children. 
Frequently it is difficult for older people to 
change their habits in regard to the wearing 
of wool, but there is no reason why babies and 
young children should wear it, except in very 
cold climates, and even then a mixture of wool 
and cotton is preferable. Loosely woven mesh 
cotton shirts are best for children at all ages. 
They are cheaper, more easily washed, gen- 
erally more comfortable next to the skin, and 
if they are of the right loosely woven texture 
they give sufficient warmth and allow of ab- 
sorption. In every way they have been shown 
to be more healthful and their use is advised 
in early infancy If material softer than plain 
cotton is desired, a mixture of cotton and silk 
or silk alone may be used. All of these are 
preferable to wool. In cold weather the valu- 
able qualities of air as a non-conductor of heat 
must be remembered. Several thin loosely 
woven garments are warmer than one heavy 




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PERSONAL HYGIENE 41 

one, as they allow for layers of air between the 
garments. For the same reason, several thin 
blankets on a bed will give more warmth than 
one heavy one. 

TYPE OF CLOTHING 

Outer Clothing 

Under three years of age the most con- 
venient outer garment is the romper. This is 
a one-piece suit, made perfectly plain, with 
drawers and waist in one. They should be 
made of washable material. Later, bloomers 
with blouses or smocks are suitable for girls, 
except for formal occasions, while boys may 
wear loose, washable blouses and trousers. 

Underclothing 

During the entire period between two and 
six years of age, the underclothing should 
consist of a shirt, preferably of cotton, muslin 
drawers, soft waist with shoulder straps, but 
no bones, garters attached either to bands 
which pass over the shoulders or to the lower 
border of the waist. 

Night Clothing 

For the child under six, nightdrawers are 
advised. They may be made with or without 
feet attached. The type with feet is advised 
for cold weather. In the summer ordinary 



42 HEALTHY CHILDREN 

pajamas may be used. There is no difference 
in the night clothes for the boy and the girl. 
When going to bed, the day shirt should be 
changed for a clean one which is worn only at 
night, or the child may, at as early an age as 
one year, sleep without an undershirt. 

Shoes 

For the child under two years, sandals or 
moccasins are the best type of footwear. They 
should not have any rough seams on the inside, 
and should be made with soft soles and no 
heels. After two years of age, the shoes may 
have a thin, light weight, flexible sole, but 
heels should not be allowed until the child is at 
least ten years of age. Shoes for young children 
should always be of a soft material and suf- 
ficiently large to allow the foot full and easy 
movement. The size should be at least one 
inch longer and half an inch wider than the 
foot. The toes should be broad and square. 
Except in cold weather, children should wear 
low shoes. In winter, high shoes are advised, 
and may be either buttoned or laced. They 
should never be stiffened at the ankles unless 
on a physician's advice. As children grow 
older and their play becomes more vigorous, 
a heavier type of shoe may be necessary, but 
the principle of no heels, no stiffening in the 
tops and sufficient length and breadth must 



PERSONAL HYGIENE 43 

be adhered to. For outdoor wear, rubbers or 
arctics must be provided for wet and cold 
weather. It is most important that the child's 
feet should not be wet, and they should always 
be examined when the child comes indoors, and 
shoes and stockings changed at once, if 
necessary, 

BATHING 

The pleasure of personal cleanliness can be 
impressed upon children at an early age, and 
such a habit will persist throughout life. Any- 
one who is familiar with children, however, 
knows that the bath can be made either a 
pleasure or a dreaded experience. There is a 
great lesson in the attitude of the small boy 
who will go swimming day after day, even 
when forbidden, but who will protest vigorous- 
ly when asked to take a bath in a tub. Prob- 
lems of this sort may be found in every phase 
of child care. A thing is distasteful and hard 
when we are forced to do it, but becomes a 
pleasure and a joy when we do it voluntarily, 
and in the nature of play. Every mother 
should understand thoroughly the eternal 
principle involved in Tom Sawyer's experience 
with whitewashing the fence. As long as it 
was work that had to be done, he was com- 
miserated with and considered a badly used 
person, but when he conceived the bright idea 



44 HEALTHY CHILDREN 

of lauding it as a particularly interesting occu- 
pation, and offered to allow the other boys to 
do it if they would pay him a price, immedi- 
ately it became play of the highest order. 
Teaching children to keep clean, therefore, 
needs a thorough understanding of child 
nature. It must be remembered that the boy 
who takes a swim does so for the pure joy of the 
swimming, not for the purpose of keeping 
clean, whereas he looks upon the bath only as 
a means of keeping clean, and there is no 
pleasure attached. The effort to make children 
like to bathe must begin in early babyhood, 
and as soon as the child is able to take any 
part in the process of bathing, he should be 
encouraged to do so. Floating toys are a 
help in this direction. Allowing the child to 
soap itself and to splash about to its heart's 
content, makes the bath a pleasure instead of 
a task. 

For purposes of cleanliness, there should be 
at least two warm tub baths a week, and if the 
child has been playing very hard and getting 
dirty, it may be necessary to have a cleansing 
bath every night. In addition to the evening 
warm cleansing bath, the habit should be 
established of having a cool sponge bath every 
morning. Up to the time the child is six or 
seven years old, the mother or nurse will have 



PERSONAL HYGIENE 45 

to help with the bathing. After that time, the 
child should be able to take the bath by itself. 

Cold Baths 

The cold bath is stimulating, and is best 
taken in the morning. The child should stand 
in a tub of slightly warm water and be bathed 
briskly with water at a temperature of sixty- 
five degrees/ The body should then be rubbed 
with a coarse, dry towel. The action of the 
cold water on the skin constricts the super- 
ficial blood vessels and sends the blood to the 
internal organs, thus stimulating them. 
Breathing is increased in frequency and depth 
so that the blood gets more oxygen and the 
nervous system and the mental faculties are 
stimulated. In certain children this proper 
reaction does not take place. If there is any 
blueness of the lips or fingers, if the child 
shivers and seems tired and weak, if the skin 
does not show the proper pink color, the cold 
baths should be omitted. 

Warm Baths 

The warm cleansing bath removes the sweat 
and waste matter from the skin, promotes 
bodily vigor and increases resistance to disease. 
It is more soothing in its effect than the cold 
bath, therefore it should generally be given at 
night. The water may be of a temperature of 



46 HEALTHY CHILDREN 

ninety-five to ninety-eight degrees. Until the 
child is about three years old, it is best first 
to wash the face and head with a wash cloth 
well rubbed with soap. The soap should then 
be rinsed off and the body soaped thoroughly. 
The child should then be placed in the tub and 
the body well rubbed with a fairly coarse wash 
cloth. The warm bath should not last over 
five minutes. Unless the child is very vigorous, 
it is best not to have the bath last more than 
three minutes. The warm bath has a markedly 
sedative effect upon the nervous system. Im- 
mediately after the bath at night, the child 
should be put to bed. 

If the feet or extremities are found to be cold 
after the bath, they should be rubbed briskly, 
and, if necessary, a hot water bag may be used. 
If cold feet are more or less chronic, a warm 
salt foot bath at night is advised. This can be 
prepared by adding a handful of ordinary rock 
salt to a basin of water. The feet should be 
bathed and rubbed for three minutes, then 
given a brisk rubbing with a coarse towel. All 
baths should be given in a warm room, where 
the temperature is from seventy to seventy- 
five degrees, and after the bath the child 
should be dressed immediately or put to bed. 

Soap, towels and wash cloths should be pro- 
vided for each child in the family. They may 
be of a distinct color for each, and may be 



PERSONAL HYGIENE 47 

marked with the name, but should not be used 
for any other purpose. 

SLEEP AND QUIET 

Rest and quiet are essential throughout the 
period of bodily growth. At the time when 
great structural changes are going on in the 
child's body, it is absolutely necessary that a 
large part of every twenty-four hours should 
be set aside for physical and mental adjust- 
ment. During the waking hours, certain parts 
of the body have brief periods of repose. There 
is a definite rest period between the heart 
beats. In winking the eyes, there is a brief 
period of rest. Muscular activity and nervous 
activity are not constant, but only during the 
period of sleep is there a cessation of all vol- 
untary movements, which include all of the 
actions and movements of the body controlled 
by the will. Digestion, respiration, heart 
action and the functions of the body that are 
not controlled by conscious action go on, but 
at this time the body generally has a chance 
to recuperate. It is during this period that 
the child gets the complete rest that is ab- 
solutely essential if it is to remain in good 
health. Grown people may govern their hours 
of sleep according to their individual needs and 
desires, each person being practically a law 



48 HEALTHY CHILDREN 

unto himself. With children, a fixed period 
must be adhered to. 

Late bedtime, with irregular sleeping hours, 
are particularly harmful to the child. Early 
rising has its merits, but is entirely wrong if 
early bedtime also is not insisted upon. Up 
to the third year the child should sleep twelve 
hours at night and should have at least one 
nap of two hours duration in the daytime. 
From three to six years, there should be not 
less than ten hours sleep at night, with a two- 
hour nap in the daytime. If for any reason it 
is impossible to have the nap in the afternoon, 
the length of the night sleep should be in- 
creased accordingly. There should be a fixed 
time for going to bed and nothing should be 
allowed to interfere with this schedule. A 
seven o'clock bedtime is late enough for any 
child under six years of age, and in the winter 
the bedtime may be as early as six- thirty. 
The best time for the nap is in the afternoon, 
preferably soon after lunch. It should be 
arranged for sufficiently early so that there 
will be a definite period between the end of 
the nap and bedtime, otherwise it will be prac- 
tically impossible to make the child go to sleep 
again. In general, it is easier to get the child 
to take a nap in the afternoon than in the 
morning, when it is refreshed after the night's 
rest. 



PERSONAL HYGIENE 49 

Even if the child does not sleep, the daily 
habit of the rest period is advisable, and there 
should be a quiet two hours every afternoon, 
with no boisterous play. This is one of the 
times w T hen the mother may have her own 
particular quiet companionship with her child, 
reading stories or playing simple quiet games, 
which do not involve any muscular activity. 

To have comfortable and proper sleep at 
night, the room should be weH ventilated, with 
a temperature not above sixty degrees. It is 
well to accustom the child to sleeping on a 
fairly firm bed. Pillows may or may not be 
provided, but if they are they should be thin 
and firm. The last meal of the day should be 
taken at least one hour before bedtime, and 
should always be light in character and easily 
digested. The child should be put to bed in 
loose, comfortable night clothing. The bed 
clothing should be warm enough, but without 
much weight. It should be placed loosely over 
the child and may be pinned on either side 
with large safety pins which are made for the 
purpose. It is best, in the beginning, to ac- 
custom the child to going to bed by itself. 
While there is great temptation to have a 
story hour just before bedtime, or perhaps a 
little extra coddling by the mother, this should 
preferably be done in the afternoon. The child 
should be placed in a darkened, cool room, in 



50 HEALTHY CHILDREN 

a comfortable bed, then left alone. Children 
soon learn that they are expected to go to 
sleep at this time, and there really is no dif- 
ficulty with a child who has been well trained 
in this respect. It is a habit, though, that 
/ may easily be changed, and if the child finds 
that it can have company by crying for it, it 
will cry every night until it gets what it wants. 
Disordered sleep is almost always an indica- 
tion that something is definitely wrong, either 
physically or in the training of the child. The 
physical causes of bad sleep may be poor 
ventilation, so that the child is restless and 
irritable, and does not get enough fresh air to 
breathe, or generally bodily discomfort due to 
tight clothes or bed clothing too tightly tucked 
in, or wrinkled sheets. Indigestion, due to 
eating too rapidly or to improper food, is fre- 
quently a cause of wakefulness. Children who 
have enlarged tonsils and adenoid growths 
sleep badly. They are almost always restless, 
turning from side to side in bed and frequently 
crying out in their sleep. A somewhat similar 
condition may be noted when a child has 
worms. Here we may have gritting of the 
teeth, picking at the nose and extreme rest- 
lessness. Inability to go to sleep at the proper 
time is usually caused by too much excitement 
at bedtime. The child should be perfectly 
quiet after supper, and there should be no 




Good Posture 



PERSONAL HYGIENE 51 

romping games or excitement of any kind. 
All playing should be done during the day- 
time, and supper and bedtime should be 
quiet and undisturbed. 

Sleep sometimes is delayed by fear on the 
part of the child. Often we can trace this fear 
back to fright or to some story that the child 
has heard. There can be nothing more repre- 
hensible than for a mother or nurse to control 
a child by reciting some fear-compelling story. 
It is not at all uncommon for children to be 
told that if they do not go to sleep, either for 
the nap or at night, or if they do not do cer- 
tain things, a giant or some ferocious animal 
will come and carry them off. Such stories 
make a deep and lasting impression upon the 
imagination of the little child, and when they 
are in the dark, by themselves, the fears return 
in such hideous proportions that self-control 
is out of the question. The way to meet this 
condition is by means of prevention, but if the 
harm has already been done, the child's con- 
fidence must be won, and the utmost tact and 
care used in reassuring it as to its safety. Such 
children should never be punished or treated 
harshly. They should be told they are safe, 
that no harm can possibly come to them, and 
this must be repeated until they believe it. 

The proper treatment for other forms of 
disordered sleep consists in removal of the 



52 HEALTHY CHILDREN 

cause. Attention to the presence of physical 
defects and their correction, a quiet hour be- 
fore bedtime, a well ventilated room, proper 
feeding and the correction of any constipation, 
comfortable bed clothing, and, if necessary, a 
hot water bag at the feet, are often all that are 
needed. It must be remembered that going 
to sleep at night is largely a matter of habit, 
and the cultivation of this habit must be 
followed in a regular and orderly manner. The 
child should not be taken up after it has once 
been put to bed unless to have its bowels 
move or to pass urine. After this has been 
done, it should be returned to bed, the room 
made quiet and dark, and the child should be 
left alone. Some children have learned to sleep 
with a dim light in the room. There is no 
particular harm in this, provided the light is 
shaded, nor is there any reason why the 
blinds of the windows should be closed. Chil- 
dren as well as adults dislike to feel that they 
are shut in. Under no circumstances should 
there be a glaring light or one that shines in 
the face of the child. 

NIGHT TERRORS 

Children from two to six years of age some- 
times have what are known as "night terrors/ ' 
The child will go to sleep as usual and then, 
several hours later, will awaken suddenly with 



PERSONAL HYGIENE 53 

startled cries. The child is almost frantic with 
fear and apprehension, and if old enough will 
often call loudly for help. Sometimes it takes 
a long time to quiet children when they awaken 
in this way. The attacks may be repeated for 
many nights in succession, or there may be 
definite intervals between them. 

Cause 

Night terrors have the same cause as any 
kind of disordered sleep. The reason why a 
child awakens suddenly may be simply an 
acute attack of indigestion. Any other physical 
abnormality that would cause bad dreams 
would produce the same effect, and the habit 
is soon established. Some of the most com- 
mon causes of night terrors are the presence 
of adenoids or enlarged tonsils, acute indiges- 
tion or some local irritation, such as pin worms. 
Over excitement is very apt to result in this 
sudden fright at night. 

Treatment 

The treatment of night terrors consists in 
removal of the cause and placing the child in 
good physical condition. Light diet before 
going to bed is extremely important and every 
effort should be made to see that the child is 
comfortable. 



54 HEALTHY CHILDREN 

HYGIENE OF THE NOSE AND THROAT 

The bacteria which cause contagious diseases 
nearly all gain entrance to the body through 
the mouth and nose. If the child is in a 
healthy, normal condition, breathes properly 
through the nose, and has a mouth that is 
clean and well cared for, the danger of con- 
tracting contagious disease is greatly reduced. 
The nose is the proper organ for breathing. 
Before air is received into the lungs, it should 
be clean, moist and slightly warm. The nasal 
passages are lined with mucous membrane, and 
this is covered with fine cilia or hairs. When 
the air passes through the nostrils, these cilia 
act as fine sieves or filters, and take out of the 
air practically all of the irritating dust. The 
mucous membrane lining the nose is also well 
supplied with small blood vessels which lie 
very near the surface. As the air goes through 
the nasal passages, it is warmed by its contact 
with these blood vessels. Although the nasal 
passages lead directly back to the upper part 
of the throat or pharynx, their surface is quite 
irregular, giving a large area that comes into 
contact with the inhaled air. This mucous 
membrane normally secretes a certain kind of 
moisture, so that the air in this way becomes 
moist. When air is breathed through the 
normal nose, we have it properly warmed, 



PERSONAL HYGIENE 55 

cleaned and of the right degree of moisture. 
When air is breathed through the mouth, it is 
taken into the lungs without this change. 

Care of the Nose 

Normally, the nose does not require any 
special care during childhood, except to see 
that it is kept clean. The child should be 
taught at an early age to use a pocket hand- 
kerchief and how to blow the nose. A certain 
amount of mouth breathing may be caused 
not by any real obstruction of the nasal pas- 
sages, but by a nose that is so filled with mucus 
that the air cannot pass through the nostrils. 
It is not wise to wash out the child's nose. 
During the first two years the mother will 
have to urge the child to blow its nose and 
give a good deal of assistance. After that 
time the child who is properly trained should 
blow its own nose when it is necessary. 

CARE OF THE THROAT 
ADENOIDS 

When air is breathed through the nose, it 
passes directly into what is known as the 
"pharynx" or upper part of the throat, from 
which it passes into the larynx, then into the 
bronchi or breathing passages of the lungs. In 
young children the pharynx is small. The 
space in it, in relation to the size of the person, 



56 HEALTHY CHILDREN 

is less than in adult life. In nearly all children 
there may be found in the pharynx a small, 
soft mass of tissue which is called an "adenoid" 
and sometimes is referred to as the "third 
tonsil/ ' In some instances the adenoid growth 
is so small that it does not cause disturbance 
nor obstruction, and its presence may be con- 
sidered normal. Occasionally, however, the 
tissue composing the adenoid grows to abnor- 
mal size, thus blocking the air passages, and 
preventing the air from passing through the 
nose. Adenoids are much more likely to 
obstruct the nasal passages in early childhood 
than they are later. They increase in size up 
to eight or ten years of age. After that the 
pharyngeal vault grows more rapidly in size, 
and the adenoids tend to shrink, so that, 
generally at about the time of adolescence, or 
from fourteen to sixteen years of age, the 
obstructive symptoms of the adenoid growth 
disappear. By this time, however, great harm 
may have been done if the adenoid has not 
received proper attention. (See illustration 
opposite page 64.) 

Causes of Adenoids 

While adenoid growths are apt to occur in 
any child, no matter how well cared for it may 
be, they are found more frequently among 
children whose hygienic surroundings are im- 



PERSONAL HYGIENE 57 

proper. One of the commonest causes of their 
production is lack of fresh air and proper 
ventilation. The air in sleeping or living 
rooms is apt to be too dry or overheated. 
Adenoids frequently result from the use of 
pacifiers or from thumb-sucking in infancy. 
Lack of proper nutrition may also be a pre- 
disposing cause. 

Symptoms 

The most prominent symptom is that of 
mouth breathing. The appearance of a child 
who cannot breathe through its nose is so 
characteristic that, once seen, it is rarely for- 
gotten. Owing to the reduced amount of air 
that is taken into the lungs, the child generally 
has a sunken, narrow chest, with shoulders 
protruding forward. The face has a pale ex- 
pression and a generally stupid look. Fre- 
quently there are dark circles under the eyes, 
and many indications of undernourishment. 
Sometimes there is nasal catarrh, with con- 
stant discharge from the nose. Such children 
are particularly susceptible to infectious 
diseases of all kinds and seem to have little, 
if any, physical resistance. The mentality 
may seem impaired and in some instances the 
child is retarded mentally, and sometimes is 
considered to be mentally defective. There is 



58 HEALTHY CHILDREN 

impairment of the senses of smell, taste and 
hearing, with liability to earache and infection 
of the inner ear. Colds and bronchitis are 
common. Frequently there are enlarged glands 
in the neck, and the child is susceptible to sore 
throat. 

Prevention 

This includes attention to the hygiene of 
the child. Care must begin in infancy. Fresh 
air, proper food, attention to the hygiene of 
the mouth and nose, outdoor sleeping, plenty 
of exercise in the open air are important. 
Direct contributing causes, such as the use of 
a pacifier and thumb-sucking, must be cared 
for in infancy. 

Treatment 

Adenoids do not require attention unless 
secondary symptoms are shown. When there 
is any obstruction, however, in the nasal 
breathing, if the child suffers from earache or 
nasal catarrh, or if any marked symptoms of 
the presence of adenoids are shown, the re- 
moval of the adenoid is advised. There are 
sometimes reasons why this operation should 
not be performed. The child should be ex- 
amined by a competent physician and his 
advice followed. 



PERSONAL HYGIENE 59 

ENLARGED TONSILS 

The tonsils are two masses of lymphoid 
tissue, situated one on either side of the throat 
at the back of the tongue. Ordinarily they 
may be seen quite readily, particularly if a 
tongue depressor is used, or if the child says 
"ah." In the normal child, a small amount of 
tonsillar tissue is present, and the mere fact 
that the tonsils are large is not an indication 
for their removal. The tonsils should receive 
attention only when they are so enlarged that 
they obstruct the throat or when they are 
diseased, and so become a menace to the 
general health. Enlargement of the tonsils 
occurs early in life and usually reaches its 
height between the eighth and tenth years. 
After that time there is a tendency for them 
to become smaller and rarely, if ever, is there 
any added growth after adolescence. The over- 
sized tonsil or one that is diseased, however, 
should be removed early in childhood, because 
of the danger that may result from its presence. 

Causes 

The causes of enlarged tonsils have not been 
definitely determined. There is known to be 
some relation between enlarged tonsils and 
frequent attacks of tonsillitis and a rheumatic 
tendency. Poor hygienic surroundings, partic- 
ularly lack of fresh air and improper ventila- 



60 HEALTHY CHILDREN 

tion, are contributing causes. Enlarged ton- 
sils are frequently associated with adenoid 
growths and also with septic or unclean con- 
dition of the mouth, due to decayed teeth. 

Symptoms 

When the tonsils are sufficiently large to 
cause obstruction of respiration, adenoid 
growths are usually present also. In such 
cases, mouth breathing results, with all its 
accompanying conditions. Speech is apt to 
be thick and full, the child snores in its sleep, 
anemia and malnutrition result, and the facial 
expression of the child changes. When the 
tonsils are diseased, attacks of tonsillitis and 
sore throat are common. There may be in- 
fection of the middle ear. The germs of 
diphtheria, influenza, scarlet fever and tuber- 
culosis commonly find their resting place in 
diseased tonsils and gain entrance to the body 
in that way. Thus, the possibility of con- 
tracting infectious diseases is greatly increased 
and the presence of the tonsils, particularly 
when they are associated with adenoids, lowers 
the bodily resistance to such an extent that 
the child is constantly "catching" some form 
of disease. 

Treatment 

In cases of very large tonsils, causing ob- 
struction, or in instances where the tonsils are 



PERSONAL HYGIENE 61 

diseased, complete removal is the proper treat- 
ment. The relief after operation for removal 
of both adenoids and enlarged tonsils is usually 
marked. The habit of mouth breathing may 
continue for a time, and the child should be 
watched carefully and instructed after such 
an operation, to see that the proper method 
of breathing is re-established. 

CARE OF THE TEETH 

An unclean mouth, with decayed teeth, 
gives the most perfect condition for the growth 
of bacteria. The cavity in a decayed tooth 
affords darkness, moisture, warmth and food 
— all the factors that are necessary for suc- 
cessful bacterial growth. Decayed teeth are 
the most widespread of the physical defects 
found in childhood. Examinations made in 
the schools of the country show that from 
seventy-five per cent to ninety per cent of the 
children have one or more decayed teeth. 
Usually, by the time the second teeth have 
appeared, the proper opportunity for preven- 
tion of tooth decay has passed, to a great 
extent. Sound teeth are of such vital impor- 
tance to the future health and development of 
a human being that no effort should be too 
great to secure proper preventive measures as 
soon as the first tooth appears. 



62 HEALTHY CHILDREN 

Temporary Teeth 

The temporary teeth are twenty in number, 
ten each on the upper and lower jaws. They 
appear at about the following ages: 



Month 


Teeth and Location 


5 to 8 


Two lower central incisors. 


8 to 12 


Two upper incisors. 


12 to 18 


Four lower lateral incisors. 


12 to 18 


Four front molars, two each on upper and lower jaws. 


18 to 24 


Four canine teeth, two on upper jaw known as "eye 




teeth"; two on lower jaw, known as "stomach 




teeth." 


24 to 30 


Four back molars 



Usually the lower teeth appear before the 
upper ones. 

The importance of the care of these tem- 
porary teeth is not generally recognized. 
Mothers who are careless pay no attention to 
this matter, feeling that, as the child is to lose 
these teeth so soon, it is useless to spend 
money on their care or preservation. The per- 
manent teeth are directly under the temporary 
ones, and decay of the first set is apt to spread 
so that the second set is infected and the latter 
decay almost as soon as they appear. Too 
early extraction of the temporary teeth causes 
the jaw to change its shape, and the second 
teeth, instead of replacing the first ones 



PERSONAL HYGIENE 63 

■ '..■., , , . 

normally in their proper positions, are pushed 
to one side, grow in crooked or by their 
crowding alter the shape of the jaw. 

Permanent Teeth 
These are thirty-two in number, sixteen on 
each jaw. The time of their appearance is 
about as follows: 



Years 



Teeth and Location 



5 to 6 

6 to 7 

7 to 8 
7 to 9 
9 to 10 

10 to 11 

11 to 13 

12 to 15 
17 to 23 



First molars. 

Lower central incisors. 

Upper central incisors. 

Lateral incisors. 

First bicuspids. 

Second biscuspids. 

Canines. 

Second molars. 

Third molars (wisdom teeth.) 



The first or ' 'sixth-year' ' molars deserve 
special consideration. Generally they appear 
before any of the temporary teeth have been 
lost through natural causes, and as a result 
they are often mistaken for temporary teeth 
and allowed to decay. They come in directly 
back of the second molars of the first set of 
teeth. They are the most important teeth we 
have for grinding purposes, and their loss 
leads to decided impairment of the function 
of the teeth, besides contributing to the pro- 
duction of misshapen jaws. It has been 



64 HEALTHY CHILDREN 

startling to discover, in examining the children 
who are entering school for the first time, that 
seventy-five per cent of the sixth-year molars 
are decayed almost as soon as they appear. 
This is another reason why early instruction 
in oral hygiene or care of the first teeth as- 
sumes so much importance. Normally, the 
first teeth will drop out or can be removed 
with a very slight pull as soon as the per- 
manent teeth that are behind begin to push 
their way through the jaw. 

Causes of Tooth Decay 
Two main causes of tooth decay are un- 
cleanliness of the mouth and teeth, and putre- 
faction of food in the mouth. The decay is 
caused by the action of the bacteria on food 
particles, producing an acid which acts upon 
the enamel of the teeth, dissolving out the 
lime salts and starting the first step toward 
decay. The habit of mouth breathing due to 
nasal obstruction, improper feeding of soft 
foods, eating of sweets, and particles of food 
of all kinds left in the mouth and between the 
teeth, hasten decay. 

Symptoms 

The results of tooth decay are so numerous 

that it is difficult to mention all of them. 

Toothache is usually the symptom which first 

calls our attention to the need of care of the 








Month Breathing Due to the Presence of Adenoids 



PERSONAL HYGIENE 65 

teeth. It is, however, nothing more than a 
warning. Sore or decayed teeth, or a jaw 
from which teeth are missing, cause the child 
to chew its food very little, if at all, and to 
swallow it in that condition. The result is 
that the child has indigestion, resulting in 
anemia and malnutrition, with all the symp- 
toms that go with those conditions. Another 
direct effect of bad teeth may be the occur- 
rence of ulcerated teeth or gum boils. The 
lymph glands in the neck may become en- 
larged and inflamed. Decayed teeth form 
an excellent breeding place for germs. The 
child is apt to contract infectious diseases, and 
the improper chewing of food, with resulting 
malnutrition, leads to lack of bodily resistance 
to disease. Such children are apt to.be irri- 
table, nervous, extremely restless and there is 
no doubt whatever that in some instances 
where the child is almost incorrigible, the 
cause is the continued nervous irritation from 
badly decayed teeth and constant toothache. 
Headache is sometimes caused by improperly 
cared for teeth. 

Prevention of Decayed Teeth and Jaiv 
Malformation 

During the period of pregnancy the mother 
can do much to assure good teeth to her child. 
She should eat not only wholesome, nourishing 



66 HEALTHY CHILDREN 

food, but food containing a proportion of 
lime salts which are so essential in the proper 
formation of bones and teeth. Cereals, whole 
wheat bread, milk and eggs, are all needed for 
this purpose. Absolute cleanliness and care 
of the mouth of the child should be begun in 
earliest infancy. As soon as the first teeth 
appear, they should be washed after each 
feeding. For this purpose a soft linen cloth or 
piece of absorbent cotton should be wound 
around the little finger of the mother or nurse. 
This should be dipped in a solution of soda 
bicarbonate (baking soda), one teaspoonful to 
a pint of water. The mouth does not need to 
be washed out, but the teeth should be 
cleansed carefully. From the time the child 
is two years old, a soft toothbrush should be 
used for this purpose. By the time the child 
is three years old, it should be able to use the 
toothbrush itself. The teeth should be washed 
night and morning, and, if possible, after the 
noonday meal. 

Many methods of brushing the teeth have 
been advocated. One consists in brushing 
the upper and lower sets separately with a 
circular motion of the brush, and one in brush- 
ing the teeth directly up and down. In either 
method, care should be taken to see that the 
inside of the teeth is brushed as well as the 
outside. 



PERSONAL HYGIENE 67 

One of the best ways to clean the teeth, and 
at the same time help to make them stronger 
and firmer, is the use of some food which re- 
quires thorough chewing. At one year the 
child may be given dry crusts of bread and 
zwieback. For at least two meals of the day 
there should be some article of food which the 
child must chew thoroughly. It is probable 
that the reason why primitive races had good 
teeth was that they had to do their tooth 
cleaning in this manner. Their food was not 
prepared in the careful way in which ours is, 
and the chewing of tough food not only kept 
the teeth in a cleanly condition, but made 
them strong and less likely to decay. 

If it is at all possible, the child should be 
taken to the dentist at least once every six 
months after the first teeth appear. At that 
time the dentist can see whether the gums and 
teeth are in good condition, whether there is 
any possibility of the jaw becoming malformed, 
and if there is any slight corrective work to 
be done. The small expenditure that is re- 
quired for such care will be repaid many 
times in later life. The condition of the second 
teeth depends so largely upon the first teeth, 
and the type of habits the child has acquired 
with regard to the hygiene of the mouth, that 
no effort can be considered too great to keep 



68 HEALTHY CHILDREN 

the first teeth in good condition and to 
establish proper habits of mouth hygiene. 

EYES AND EARS 

The ear itself should receive no particular 
attention, except the care that is essential for 
cleanliness. Under no circumstances should 
an attempt be made to clean out the ear with 
any instrument, whether of metal or wood. 
The outer ear should always be kept clean, but 
the ear canal should be left alone. The most 
common affection of the ear in childhood is 
earache, which is referred to in the chapter on 
"The Common Diseases of Childhood.' ' Deaf- 
ness, however, is such a serious matter that 
there should be some consideration of the 
hygiene of the ear, particularly as it relates to 
care of the nose and throat. 

CAUSES OF MIDDLE EAR DISEASES OR 
DEAFNESS 

Adenoids and enlarged tonsils, with result- 
ant chronic catarrh, are contributory causes 
to disease of the middle ear. There are two 
fine tubes, known as the "eustachian tubes," 
which run directly from either side of the 
throat to the middle section of each ear canal. 
In any acute inflammation of the throat or 
pharynx, or in cases of diseased tonsils or 
adenoids, there is the possibility of some in- 
fection going through the eustachian tube to 



PERSONAL HYGIENE 69 

the middle ear and causing middle ear disease. 
Neglected colds also may be a cause of some 
inflammation of the middle ear. 

Symptoms 

Earache is referred to elsewhere. The early 
signs of deafness may be the result of inflam- 
mation of the middle ear and consequent 
rupture of the eardrum, or it may be the result 
of wax that is imbedded in the outer ear canal. 
Usually it is manifested first by the child's 
inattention. Frequently this is thought to be 
stupidity when in reality it is inability to hear 
properly. Occasionally, children will show this 
condition by the attitude of straining to hear 
when spoken to. There may be some impair- 
ment of speech. 

Prevention 

Attention should be paid to all hygienic 
measures of child life. Any attack of earache 
should lead to examination of the child to 
determine the presence of adenoid growths or 
enlarged, or diseased tonsils. These should 
receive immediate attention. 

Treatment 

Treatment of deafness can be outlined only 
by a qualified physician, and on the first 
symptoms or indication of any deafness the 
child should be taken to a doctor at once. It 



70 HEALTHY CHILDREN 

may be that the only treatment necessary will 
be removal of the wax from the outer ear. 
However, if there is actual impairment of 
hearing, due to disease or as the result of 
disease of the inner ear, specialized care should 
be given as early as possible. 

CARE OF THE EYES 

Infectious diseases of the eyes are considered 
under the chapter on "infectious contagious 
diseases." Ordinary hygiene of the eyes, how- 
ever, is important in prevention of eyestrain 
and its early correction and to detect defect- 
ive vision. 

CAUSES OF DEFECTIVE VISION 

In early life the causes of defective vision 
are eyestrain or some abnormal condition of 
the eye. 

Symptoms 

The symptoms of eyestrain and defective 
vision in early life are so closely related that 
they may be considered together. The child 
may complain of discomfort or even pain in 
the eyes, particularly if it has been playing at 
a game which requires close vision. The eyes 
may itch, smart or burn. There may be in- 
crease in the tear secretion so that the eyes 
water frequently. The conjunctiva or white of 
the eye and the inner surfaces and edges of the 



PERSONAL HYGIENE 71 

lids may become congested, red and inflamed. 
Sometimes there is sensitiveness to light. 
Books and toys are held close to the eyes and 
there is evidence that the child does not see 
clearly. Occasionally the only symptom noted 
will be that the child is frowning. Reflex or 
indirect symptoms of eyestrain are headache, 
nausea, indigestion, car sickness, dizziness, 
nervousness, outbursts of temper, twitching 
of the facial muscles, sometimes stuttering or 
stammering, and there may be impairment of 
the general health. Some cases of under- 
nourishment can be traced to continued eye- 
strain. 

Prevention of Eyestrain 

In young children the eyes should be shielded 
from strong light. When they begin to read 
books, those with large print and unglazed 
paper should be used and they should never 
read in a dim light or by artificial light, unless 
the latter is placed in such a position that the 
rays will come over the child's left shoulder. 
It is not necessary to wash out the child's eyes 
daily, but after playing in a dusty place or if 
there is the slightest sign of inflammation of 
the eyes, it is well to wash them out carefully 
with boric acid solution. This can be done by 
having the child sit in a low chair, with head 
bent back so that the child is looking directly 



72 HEALTHY CHILDREN 

at the ceiling. A perfectly clean piece of gauze 
or absorbent cotton should be wet with boric 
acid solution and held about two inches above 
the eye, then squeezed gently, The excess 
solution may be wiped off lightly, but the eye 
should not be rubbed. If any sign of eye- 
strain develops, the child should be taken to an 
oculist at once. Defective vision in later life 
may often be prevented by the use of properly 
adjusted glasses during the early years. 

Treatment of Defective Vision 

If defective vision is found to exist, the act- 
ual treatment must be left entirely to the 
physician. 

Squint (Cross Eye) 

The eyeball is held in place in the eye-socket 
by means of small muscles. Occasionally one 
of these muscles will become contracted so 
that the eyeball will be pulled in that direc- 
tion, thus causing what is known as ' 'squint' ' 
or ■ 'cross eye." This condition is not uncom- 
mon in young babies but tends to disappear in 
later life. If it continues after the third month, 
prompt attention should be given to it. Squint 
usually results in overstraining the eye that 
has normal muscles, and also results in poor 
vision in the affected eye. Occasionally, squint 
may be corrected by the use of proper glasses 



PERSONAL HYGIENE 73 

prescribed by a competent oculist. In other 
cases, a slight operation, which consists in 
cutting the contracted muscle, may be neces- 
sary. This cannot be decided, however, by 
anyone but a physician who has had an op- 
portunity of examining the child. 



CHAPTER III 

TRAINING FOR GOOD HABITS 

The establishment of proper and regular 
habits in any child begins at the time it is 
born. A baby soon learns that if it cries to be 
taken up and its wish is gratified, it can 
get anything it wishes by crying for it, and the 
habit is established. For the immediate com- 
fort of both mother and child, as well as for the 
future good of the child, proper habits should 
be established as early as possible in infancy. 
Reference is made here particularly to physi- 
cal habits. Mental habits, and those which 
have to do with proper mental training and 
discipline, are considered elsewhere. 

REGULARITY 

The most important single item in training 
a child to maintain good health is regularity. 
The time and number of baths each week 
should be outlined, and the schedule adhered 
to. Meals should be at definite and regular 
hours. The child should go to sleep at a stated 
time and get up at a regular time. If naps 
are necessary, as they always are for children 
of preschool age, the child should have its nap 
at a definite hour each day. It is not neces- 
sary to make life a matter of sheer routine, by 
planning out a time table for the child and 

74 



TRAINING FOR GOOD HABITS 75 



following it, for after a very short time the 
habit of regularity becomes so fixed that it is 
not irksome or hampering in any way, and 
without question the child expects certain 
things at certain hours of the day, and learns 
to meet them. Such training lays the founda- 
tion for excellent mental habits and is the best 
beginning we can make toward the right kind 
of discipline. 

TRAINING THE BLADDER 

A beginning can be made in teaching the 
child to control its bowels and bladder at as 
early an age as six weeks to two months. A 
very small chamber or a small, deep dish with 
wide, spreading edge, should be selected. For 
the purpose of training the bladder, the 
mother should sit in a chair and place the 
chamber in front of her, holding the child over 
the chamber with its back resting against her 
knees. This should be done at least four times 
a day, at regular intervals. In addition, the 
baby should be placed over the chamber the 
last thing at night, and if it is awakened for a 
night feeding, the opportunity may be taken 
to repeat the procedure. 

Training the child to pass its urine in this 
way is a much more difficult task than train- 
ing the bowels, but if persisted in and kept up 
regularly, it frequently is possible within a 



76 HEALTHY CHILDREN 

few weeks to train the baby so that it knows 
exactly what is expected of it, and when placed 
on the chamber it will pass its urine. Even 
if such training does not begin at the very 
early age mentioned it should never be neglect- 
ed beyond the eighth or ninth month, and if 
begun at that time it is almost always possible 
to train the child so that, by the time it can 
run about, it is able to control its bladder, and 
to make known when it wishes to pass urine. 

BED-WETTING 

With proper training, a child should learn to 
control its bladder by the time it is a year old. 
Occasionally, however, there are cases where, 
with the best of training and perfect control 
during the daytime, the child seems unable 
to avoid wetting the bed at night. Occasion- 
ally, children have good habits in this regard 
until they are four or five years old, then 
suddenly begin the habit of bed-wetting. 

Causes 

When a child continues to urinate at night, 
notwithstanding all efforts that have been 
made to control the habit, the cause is usually 
beyond its control and consists of some 
physical defect or irritation. It may be that 
the child is suffering from enlarged tonsils or 
adenoid growths, which prevent proper breath- 



TRAINING FOR GOOD HABITS 11 

ing and cause extreme restlessness throughout 
the night. Chronic constipation, pin worms or 
some other irritation around the genital organs 
are also exciting causes. Wrong feeding, that 
is, food taken late at night or too much liquid, 
contributes toward the habit of bed-wetting. 

Treatment 

The establishment of good habits is the 
most important and first method to be fol- 
lowed. The child should be taught to have 
regular times for passing the urine throughout 
the day, and should be placed on the chamber 
at such regular intervals. It may be neces- 
sary to do this as often as once every hour in 
the beginning of the treatment, but the in- 
terval can be lengthened later to once every 
three or four hours. In every instance, how- 
ever, the child must be placed on the chamber 
the last thing at night and once or twice 
during the night. The diet should be adjusted 
so that the child has no liquids after four p. m. 
Supper should be very simple, consisting of 
easily digested foods such as cereal with butter 
but no milk, some crackers or toast, and 
stewed fruit. If physical defects are found to 
exist, they should be removed. The suspicion 
that pin worms may be present should be in- 
vestigated and proper treatment given. Con- 
stipation must be corrected, and it may be 



78 HEALTHY CHILDREN 

necessary to have an examination made of the 
child to see if there is any irritation about the 
genital organs. If other methods fail, raising 
the bed at the foot should be tried. Blocks 
may be placed under the foot of the bed so 
that it is raised four or five inches. The child 
should sleep without a pillow, so that the head 
may be distinctly iower than the rest of the 
body. 

Sometimes bed -wetting is caused by the 
child habitually lying on its back. An easy 
way to correct this tendency is to take a long 
strip of muslin and tie a knot in the center. 
The strip should then be placed around the 
child's body so that the knot comes directly 
in the middle of the back. It should be tied 
loosely so that there will be no constriction. 
When the child falls asleep and attempts to 
lie on its back, the knot immediately makes 
it uncomfortable and causes it to turn back 
on its side. 

A child should never be punished for this 
habit. There is no doubt that children so 
affected suffer mentally from this failing and 
would gladly control themselves if they could. 
If, after all possible methods have been tried, 
the bed-wetting still continues, a certain 
amount of moral suasion may be used. Even 
in such cases, however, it is better not to use 
it in the nature of penalties, but rather in the 



TRAINING FOR GOOD HABITS 79 

nature of rewards. The child may be told 
that it may have certain things it wants or 
that it may do certain things it considers 
desirable, if the habit is controlled. When all 
home measures fail, the child should be ex- 
amined carefully by a competent physician to 
determine whether there is any physical cause 
for the continued habit. 

TRAINING THE BOWELS 

Training the bowels is not as difficult as 
training the bladder. Constipation is extreme- 
ly common in infancy, and if allowed to con- 
tinue it becomes almost chronic during child- 
hood and later life. There are few bodily 
conditions which cause so much ill health as 
constipation. The failure of the body to get 
rid properly of these waste products leads to 
a kind of self-poisoning which is always re- 
flected in some type of ill health. Learning 
to have the bowels move regularly is one of 
the cardinal points in the training of child- 
hood. The training may easily be begun when 
the child is not over six weeks of age. 

At that period the average child will have 
from two to three bowel movements a day, 
therefore the training can take place at the 
same time that the child is placed on the 
chamber to pass its urine. At first no results 
will be noticed. The child will not under- 



80 HEALTHY CHILDREN 

stand what is expected of it, and in all prob- 
ability the bowels will not move. The main 
point is to establish the habit of putting the 
child on the chamber at exactly the same 
time each day, preferably immediately after 
breakfast, before the afternoon nap and the 
last thing in the evening. The training hours, 
once established, must be adhered to strictly. 
If the bowels do not move after the first week 
or two of this schedule, it is permissible to use 
a small soap or gluten suppository. These 
will almost always stimulate the bowels to 
move, and if used only at the time the child is 
placed on the chamber, it will soon learn just 
what is expected at this time. Ordinarily, after 
a few weeks, it will not be necessary to use a 
suppository and the child will have a perfectly 
normal movement. without it. 

CONSTIPATION. 

Causes 

Neglect of a regular time for bowel move- 
ments is the most ordinary cause of constipa- 
tion. The next most prominent cause is the 
wrong type of feeding. The child does not get 
enough coarse food to eat — that is, whole 
wheat bread, cereals or fibrous vegetables. 
Frequently, children do not have enough 
variety in their food, and not enough liquid. 
Occasionally, a child is getting too much milk. 



TRAINING FOR GOOD HABITS 81 

Some parents have the idea that because milk 
is a very nutritious and wholly desirable food 
for young children, it may be given to the 
exclusion of other articles of food. That is 
not so, and the child from two to six years of 
age should not receive over one and a half 
pints of milk a day as the maximum. The 
remainder of the diet should be made up of a 
varied assortment of other types of food. 
Occasionally, children from two to six years 
of age suffer from constipation because the 
toilet seat is not adjusted to suit them. The 
seat may be too high and they cannot rest 
their feet against anything that will give their 
adominal muscles an opportunity to aid in the 
process of expulsion of the bowel contents. 

Treatment 

Chronic constipation cannot be cured by 
the use of drugs or the continued use of 
enemas. These may be used as emergency 
measures and on the doctor's advice, but con- 
tinued use of any laxative or cathartic 
medicine or enemas tends to weaken the 
natural power of the bowel to expel its con- 
tents, and ultimately makes the constipation 
much worse. 

If it is necessary to use medicine for the 
relief of constipation, milk of magnesia in tea- 
spoonful doses from one to four times a day is 



82 HEALTHY CHILDREN 

advised for very young children. A mixture 
of rhubarb and soda is a mild laxative, and 
may be given in teaspoonful doses four times 
a day. Compound licorice powder, a teaspoon- 
ful dissolved in a quarter glassful of water, is 
an excellent cathartic when given at night. 
Castor oil or calomel should be used as a 
cathartic only at the beginning of acute illness 
or when there is an indication of general con- 
stitutional disturbance. All these drugs, how- 
ever, are subject to the limitations mentioned 
above, and should be used for a short time 
only, or in the presence of acute illness or 
some other condition of emergency. 

Other adjustments in the child's life that 
are necessary to correct constipation are in- 
dicated by the causes. A regular time for 
going to the toilet is of the first importance. 
The diet should be adjusted to suit the in- 
dividual needs of the child. More rough food, 
such as cereals, whole wheat bread and fresh 
vegetables, should be given. The child should 
have fruit, preferably orange juice or prune 
juice, every morning, with stewed fruit at the 
evening meal. The amount of milk taken each 
day should be controlled with reference to the 
needs of the child, with an allowance of one 
and a half pints between two and six years of 
age. The diet should be varied. A special 
toilet seat should be built for the child, which 



TRAINING FOR GOOD HABITS 83 

can be adjusted to its growth. In addition to 
these measures, regular and systematic exer- 
cise outdoors will be found one of the greatest 
aids in controlling the habit of constipation. 

THUMB SUCKING 

Thumb sucking is a habit which is usually 
acquired in early infancy. The habit is harm- 
ful and every effort should be made to correct 
it. 

Causes 

The causes are mainly those of habit and 
possibly a nervous tendency on the part of 
the child. 

Results 

If begun in early infancy, thumb sucking 
will often cause a misshapen mouth and jaw. 
The upper jaw is apt to protrude, the lips 
become soft and flabby, the teeth may be 
irregular and the constant sucking tends 
toward the formation of adenoids and en- 
larged tonsils, with resultant mouth breathing. 
In addition, the habit is a filthy one, in that 
the child's thumb may be dirty and thus 
convey infection to the mouth. Some children 
suck a finger instead of a thumb, but the results 
are the same. Occasionally, young children 
have the habit of sucking a piece of bed 
clothing or their own clothing, or some other 



84 HEALTHY CHILDREN 

object. Such cases vary little, either in their 
results or treatment, from thumb sucking. 

NAIL BITING 

This habit usually begins when the child is 
two or three years of age. It is more common 
in nervous, shy children, who may acquire the 
habit as a means of covering embarrassment. 
It may be acquired, also, as the result of copy- 
ing the habit in others. Once acquired, it 
persists even into adult life, if strenuous efforts 
are not made to control it. The results are 
shown in badly disfigured nails and 'fingers. 
At times the biting goes on to such an extent 
that the nails are almost completely bitten 
away, and may even become badly infected. 
The habit is so disfiguring that every effort 
should be made to control it at as early an age 
as possible. 

Treatment 

The treatment of thumb sucking and nail 
biting should be wholly mechanical. The use 
of bitter drugs on the ends of the fingers has 
not been found to be successful, and their long 
continued use may easily result in upsetting 
the child's digestion. 

For very young children, round aluminum 
mits which fasten over the child's hands are 
sometimes used, but they are not as good as 
a form of elbow cuff. The aluminum mits 



TRAINING FOR GOOD HABITS 85 

prevent the child's putting its fingers into its 
mouth, it is true, but at the same time they 
also prevent its playing or using its hands for 
any other purpose. The safest mechanical 
restraint is an elbow cuff which is made by 
taking a piece of cardboard from four to six 
inches long and from six to eight inches wide, 
depending upon the size of the child. The 
cardboard should be rolled into the form of a 
cylinder and the edges pasted or sewed 
together. Adhesive plaster may be used for 
this purpose. The cardboard should be stiff 
enough so that the cuff will not bend, and the 
cuff should fit loosely over the child's elbow, 
reaching a point midway between wrist and 
elbow at the lower edge and midway between 
elbow and shoulder at the upper edge. It 
should be fastened to the child's dress with 
safety pins. This type of cuff allows the child 
to use its hands with perfect freedom, but 
does not permit it to bend the elbows so that 
its fingers can reach its mouth. This method 
of restraint should be carried on both day and 
night until the habit is completely controlled. 

MASTURBATION 

Masturbation or self-excitement of the 
sexual organs may occur even in early infancy. 
At that time it is comparatively easy to control. 
When it occurs in later childhood, however, it 



86 HEALTHY CHILDREN 

may prove to be exceedingly difficult to deal 
with. 

Causes 

The causes of masturbation in young chil- 
dren are usually physical. There is almost al- 
ways some irritation about the genital organs. 
In the boy this may be due to a constricted 
foreskin or in the girl there may be some 
adhesions present. Occasionally the irritation 
caused by pin worms will make the child begin 
the habit of masturbation. Usually children 
are quite unconscious of the habit, except that 
it gives them a more or less pleasurable 
emotion. Older children may consciously copy 
the habit from others, but before five years of 
age it is probable that in some wholly in- 
nocent way the child observes a certain amount 
of pleasure to be obtained from friction of the 
genital organs, and thereafter repeats the 
process. 

Symptoms 

The child may be noticed handling the 
genital organs or may be seen to rub the lower 
part of the body against some article of 
furniture or the act may be accomplished by 
the child simply rubbing its thighs together. 
Usually the face becomes slightly flushed, 
followed by some perspiration, and invariably 



TRAINING FOR GOOD HABITS 87 

the child is more or less fatigued and often 
drowsy afterwards. 

Treatment 

The treatment consists in very close observa- 
tion. If the friction is carried on with the 
hands, the aluminum mits may be used. Such 
children should be kept under constant obser- 
vation throughout the day. At night they 
should be put to sleep with a pillow between 
the legs. Attention must be paid to any 
physical defect or local irritation that may be 
present, and the doctor should be consulted 
if there is any possibility of adhesions being 
present in the girl or tight foreskin in the boy. 
There is no medical treatment for this habit. 



CHAPTER IV 

FOODS AND FEEDING 

A child's health depends almost entirely 
upon its nutrition, and nutrition to a great 
extent is dependent upon the amount and kind 
of food the child eats. The science of feeding 
babies has received a large amount of attention 
for many years, because it has been realized 
that the baby's life may be dependent upon 
the selection of the proper food. After the 
weaning period, however, less attention has 
been paid to the matter, notwithstanding the 
fact that during the preschool age period we 
must lay the foundation for health in after 
life, and that any wrong feeding or under- 
nourishment during that time will affect the 
nutrition and growth of the child in a manner 
that cannot be corrected later. 

Adults need food for two purposes : replacing 
waste tissue and supplying energy. Children 
need food for these purposes, and, in addition, 
for the promotion of growth. The child's 
need of proper food for those purposes far 
exceeds that of the adult, and in proportion 
to its size, the child requires for the main- 
tenance of proper bodily nutrition three times 
as much food as the grown person needs. 

In order to determine what types of food 
and feeding are best for the growing child, 

88 



FOODS AND FEEDING 89 

it is necessary to understand something of the 
characteristics of the foodstuffs themselves. 
All foods contain one or more of the following 
elements: fats, protein, carbohydrates (starches 
and sugars), mineral matter and water. 

Fats 

Fats in food furnish energy and heat for 
the body. They serve the same purpose as 
fuel does in a stove or furnace. While some 
fat is stored in the body for the protection of 
the muscles or as a reserve which is drawn 
upon for any unusual effort or when extra 
bodily heat is essential, the main use is to give 
warmth to the body and to provide necessary 
energy. Because of their heat-giving quali- 
ties, it may readily be seen that the fats are 
more acceptable and digestible in cold than 
in warm weather. They are found mainly 
in butter, cream, cheese, oils, nuts and in 
certain kinds of meat and fish. 

Protein 

Protein in food forms the body structures; 
that is, it builds the tissues, such as the bones 
and muscles. Also, it replaces waste tissue that 
has been used up in the exercise of energy. 
Protein is of great importance in promoting 
growth. It occurs in lean meats, fish, eggs, 
milk, grain such as oats, wheat and rice, and 



90 HEALTHY CHILDREN 

in the fleshy vegetables, such as beans, peas 
or lentils. 

Carbohydrates 

Carbohydrates are taken into the body 
chiefly in the form of sugars and starches. 
They are heat and energy-producing foods, 
and are essential for growth. The starches 
occur in certain vegetables like peas, beans, 
potatoes and corn, and in the various forms 
of grain. Sugar occurs in its natural form, 
also in fruits and in many other foods. 

Mineral Matter 

Mineral matters are used mainly in build- 
ing up the mineral tissues of the bones and 
teeth. They are extremely important to 
the growing child, just as they are important 
in the diet of the pregnant woman. They 
occur in a large variety of foodstuffs such as 
the cereals, milk and eggs. They occur also 
in common salt, and may be found in certain 
vegetables such as spinach, cabbage and 
celery. 

Water 

Water is contained in food in order to hold 
the particles in suspension or to dissolve them. 
In the body, water forms a large part of all 
of the tissues and is essential to sustain life. 
It acts also as a diluent and a means whereby 



FOODS AND FEEDING 91 

waste products may be carried off from the 
organs and tissues of the body. It is present 
in practically all foodstuffs. 

Great advances have been made recently in 
the consideration of types of foods that best 
promote growth and nutrition. It seems to 
be determined that certain kinds of food, 
although appetizing and hitherto considered 
of great nutritive value, have in reality very 
little to recommend them except their taste 
and the fact that they satisfy the appetite. 
Recent investigations have demonstrated the 
presence of what are known as "vitamines" 
in certain kinds of foodstuffs. Vitamines 
are those principles in foodstuffs which fur- 
nish a certain element that is absolutely es- 
sential for growth and nutrition. These vita- 
mines have certain qualifying names: that 
is, there are the fat soluble vitamines which 
are contained in certain kinds of foods. They 
are especially abundant in butter-fat, milk, 
the yolks of eggs, cod liver oil or any other 
oil or fat of animal origin and in the leafy 
and some other vegetables. They are also 
found in kidneys, sweetbreads and liver. 
Some article of food containing these vita- 
mines must be present in the diet if proper 
growth and nutrition are to be maintained. 
The second type of vitamine is known as the 
water soluble vitamine. It is found par- 



92 HEALTHY CHILDREN 

ticularly in milk, eggs, whole wheat, tomatoes, 
turnips, the green, leafy vegetables such as 
lettuce, cabbage, cauliflower, spinach and the 
tops of beets and turnips, and the juicy fruits, 
such as oranges, lemons and grapefruit. 

There is a third vitamine, known as the 
1 'antiscorbutic vitamine/' This is the type 
of vitamine or health-giving principle which 
prevents scurvy and which is found in cer- 
tain types of fresh foods such as milk, some 
vegetables, fruit juices and the juice of to- 
matoes. In infancy, the juice of canned to- 
matoes or the juice of oranges may be used 
to prevent scurvy. This is not necessary 
if babies are breast fed or fed on fresh, raw 
milk, but is essential if the milk is pasteurized . 
After infancy, when the child is getting other 
foods, the use of some definite antiscorbutic 
food is not so essential as it is in infancy, 
nevertheless some of these foods must be 
included in the regular dietary. This is one 
of the reasons why milk, fresh vegetables and 
fresh fruits are so important for the growing 
child. 

The great importance of mineral matter, 
particularly calcium, in foodstuffs, should be 
emphasized. These salts are essential not 
only in building up the bones and teeth but 
they have a favorable influence on the body 
in general and are necessary for the main- 



FOODS AND FEEDING 93 

tenance of good health. They are found in a 
large variety of vegetables. When the latter 
are cooked in water for any length of time, the 
salts are usually extracted and remain in the 
water in which the vegetables were boiled. 
This water, therefore, has great nutritive value 
and should never be thrown away but used in 
some form of cooking. It may be made palat- 
able when used as the foundation for gravies 
or soups. 

Proper diet for any growing child, there- 
fore, must contain not only the actual food 
constituents in a reasonable balance, so that 
the needs of growth may be met, but it must 
also contain the foods in which the vitamines 
are found, otherwise the child will be under- 
nourished and underdeveloped. The proteins 
of cereals and meat are important, as are 
the starches of certain tubers and fleshy 
vegetables. The fats of vegetable origin 
will furnish heat and energy to the body, 
and all of them are needed for proper 
development. It cannot be emphasized 
too strongly, however, that any diet con- 
sisting simply of meat, potatoes or other root 
or fleshy vegetables and cereals will not main- 
tain the proper and regular nourishment of 
the body, particularly that of the growing 
child. Such foods must have a liberal ac- 
companiment of the two main types of food- 



94 HEALTHY CHILDREN 

stuffs that contain the vitamines: first, milk, 
and second, the leafy vegetables. 

TYPES OF FOOD 

Milk 

Milk in itself is an almost perfect food, and 
when necessary it can be taken alone and will 
sustain life. There is no time in the life his- 
tory of the individual when the use of milk 
should be neglected. It is the most nearly 
perfect food that we know anything about 
and is the only perfect food for the baby or 
child. 

Milk is essential for the diet of the growing 
child, but it must not be used to the exclusion 
of all other foods. There is a certain tendency 
to rely too much upon milk as a proper diet 
for young children. Even in infancy it is 
well to supplement the milk diet with some 
other types of food after the baby is from six 
to eight months old. From one to two years 
the child should have at least one quart of 
milk a day, and from two to six years, one 
and a half pints. If the milk that is used 
comes from Jersey cows, it should have part 
of the cream removed before it is used. If 
more than this amount of milk is given, the 
child is apt to be satisfied with the milk diet 
alone and to lose its appetite for other foods. 
This should not be allowed to occur. One 



FOODS AND FEEDING 95 

and a half pints of milk a day is absolutely 
necessary, and can be given partly in the form 
of fluid milk — that is, a glassful between meals 
and at night — and the rest can be given either 
in small amounts with meals or in the form 
of soups, ice cream, junket or cooked with 
vegetables. The milk given to young chil- 
dren should never be ice cold, although it 
must be kept cold in the home from the time 
it is received until it is used, and should never 
be above fifty degrees Fahrenheit in temper- 
ature, 

Cereals 

The cereals given to young children should 
be well cooked. Although there are on the 
market many types of cereals that are ad- 
vertised as already cooked, they should be 
cooked again for two or three hours. A fire- 
less cooker is excellent for this purpose, as 
the cereal can be prepared the night before 
and will be ready for use the following morn- 
ing. Dry cereals are not advised for young 
children. They do not contain an amount of 
nourishment equal to that of the cooked 
cereals and their bulk is apt to satisfy the 
child's appetite so that it will not eat other 
and more nourishing foods. The best kinds 
of cereals for young children are oatmeal, 
hominy, farina, corn meal, the wheat foods 



96 HEALTHY CHILDREN 

and rice. The latter should not be polished 
white rice but the so-called brown or natural 
rice. 

Meats 

Young children should not have meat more 
than once a day; in fact, it is perfectly pos- 
sible to fill all the requirements of a mixed 
diet if meat is given not more than three 
times a week. The best kinds are beef in 
the form of roast or beefsteak, lamb roasted 
or lamb chops or well cooked chicken. It is 
important that the child should be taught to 
chew all meat thoroughly. In this way the 
food is subdivided into small portions before 
it reaches the stomach and therefore is more 
readily digested, and the process of chewing 
is excellent for strengthening and cleaning the 
teeth. 

Fish 

Fish should never be served to a child on 
the same day with meat. Nearly all fresh 
fish that are caught in local waters are recom- 
mended. It should always be broiled or 
boiled, never fried. 

Eggs 

Eggs should not be used at the same meal 
with either fish or meat, but, unless the child 
has some marked idiosyncrasy to eggs and is 



FOODS AND FEEDING 97 

unable to eat them, one should be included in 
the diet every day. It may be either cod- 
dled, poached, scrambled or soft boiled (two 
minutes), or it may be cooked in the form of 
custard or other food. 

Vegetables 

Particular stress must be laid upon the 
value of the leafy vegetables in the diet of the 
growing child. These, with milk, form what 
are called the " protective' ' foods, without 
which growth and proper nourishment are 
impossible. When vegetables are cooked, the 
water in which they have been boiled should 
be saved and used to make soups and gravies. 
The following list of vegetables may be used 
for young children: lettuce, celery, spinach, 
well cooked cauliflower, Brussels sprouts, 
Swiss chard, asparagus, string beans, carrots, 
peas. Potatoes may be given once a day. 
They are best baked or boiled with their skins 
on, although mashed potatoes may be used 
occasionally for variety. 

Bread 

Some form of bread should be included in 
each meal, but children under six years of 
age should never eat bread that is less than 
twenty-four hours old. Toast, crackers and 
zwieback may be used by way of variety. 



98 HEALTHY CHILDREN 

Fruits 

For young children great care must be 
taken that fruits are eaten only in season and 
when not either green or overripe. Apples 
are best when baked or made into apple 
sauce. Whole berries should not be used 
until the child is over four years old, although 
the juice of berries may be given after one 
year. Peaches, cherries and grapes may be 
given in moderation, but only when perfectly 
ripe. A good rule is to use fresh fruit in 
the early morning and stewed fruit at night. 
Orange juice or the juice of canned tomatoes 
may be considered a standard article of diet 
to be used throughout the year. 

Soups 

Children may eat most varieties of plain 
soups, including meat broths, vegetable purees 
and cream soups made with milk and the 
water left from cooking vegetables. 

Desserts 

Sweets in moderation are a necessary part 
of the diet of the growing child. It is better 
however, to give them with meals in the form 
of desserts, and for this purpose the best types 
of sweets are cooked fruits, simple puddings 
made with milk, such as bread pudding or 



FOODS AND FEEDING 99 

rice pudding, baked or boiled custards, junket 
or ice cream. A small amount of sweet choco- 
late or plain sugar candy may be given for 
dessert after the child is three years old. 

Foods to be Avoided 

During the preschool age there are certain 
foods which are harmful. They have very 
little nutritive value and are too rich and 
heavy for the delicate digestive organs of 
young children. General types of food to be 
avoided are pork in any form, including ham 
and sausage, corned beef, veal, game including 
duck, salt fish, sauces and any highly spiced or 
over-seasoned food, fried foods, raw celery, 
radishes, cucumbers, green corn, raw to- 
matoes, rich cakes or puddings, pastry or hot 
breads. Children under six years of age 
should never drink tea or coffee. 

GENERAL RULES FOR FEEDING 

In childhood, as in infancy, regularity in 
feeding is of the greatest importance. 

While three meals a day for the growing child may be taken 
as a basis, during early childhood there may be an additional 
lunch either in the middle of the morning or the middle of the 
afternoon, consisting of milk or cocoa with crackers or bread. 

Meals should be given at regular hours each day and the 
routine should never be interfered with. Up to the age of six 
years, the child should have its hearty meal or dinner in the 
middle of the day, with a light supper at night. 

After the age of two years, it is better to have the child sit 
at the family table. It is understood, however, that when this 



100 HEALTHY CHILDREN 

is done the child's diet should be adhered to absolutely. When 
it seems necessary there is no real reason why a child should not 
eat alone, but the habit of eating with the family, observing 
proper mealtime habits and learning to do without foods that are 
available, is splendid training. Also, it is helpful for the mother 
who has to prepare her own meals not to have separate and ad- 
ditional ones to prepare for the child. 

There is far more harm done by overeating in childhood than 
by undereating. Care must be taken to see that the amount of 
food the child gets is adjusted to its needs and not merely to its 
appetite. 

All children need less fats in summer than in winter. During 
the hot months the amount of fats and meats eaten should be 
reduced. 

All children need water. Every child should be required to 
drink at least two glassfuls of water a day between meals and may 
be allowed one glassful with meals. Water with meals should 
not be allowed simply to wash down the food but should be taken 
throughout the meal to dilute the food and make it easier to 
swallow and digest. 

All food should be chewed thoroughly. A child should not 
be allowed to bolt its meals. 

Idiosyncrasies with Regard to Food 

Some children are unable to eat certain 
types of food. This does not mean that they 
dislike the food but that it disagrees with 
them. Usually the types of food that may 
produce certain forms of illness in sensitive 
children are eggs, certain kinds of fruit (par- 
ticularly berries), cereals and fish. The pro- 
duction of the illness may not have anything 
to do with the purity or freshness of the food 
but it is an indication that the child has some 
peculiar reaction to the particular type of 
food and is unable to eat it without suffering 



FOODS AND FEEDING 101 

from attacks of hives or sudden and acute 
attacks of vomiting or diarrhoea. If it is 
certain that the food is fresh and properly 
prepared, the child should not be again urged 
to eat it unless on the advice of a physician. 

SAMPLE DIETS FOR CHILDREN FROM ONE TO SIX 
YEARS OF AGE 

Twelve to Eighteen Months 

6 :30 to 7 :00 a. m. Juice of one orange or 

Two tablespoonfuls prune juice or 
Two tablespoonfuls pineapple juice. 

7:00 to 7:30 a. m. Two or three tablespoonfuls of cereal, such as 
oatmeal, hominy, farina, cream of wheat or 
wheatena, made very thin and served with 
milk and a small amount of sugar. 
Glass of milk (eight ounces). 

11:00 a. m. Glass of milk (eight ounces). 

Cracker or piece of zwieback or piece of stale 
bread with crust. 

1 :30 to 2 :00 p. m. One article to be selected from each of the 
following groups: 

1. Beef juice, two to four tablespoonfuls. 
Coddled egg. 

Scraped beef, one tablespoonful. 
Mutton or chicken broth, one cupful. 
Minced chicken, one tablespoonful. 
Vegetable soup, one cupful. 

2. Bread, zwieback or cracker. 

3. Baked or mashed potato, rice. 

5:30 to 6:00 p. m. Cereal and milk. 

Zwieback or stale bread, toasted. 

10:00 p. m. Glass of milk (eight ounces). 

Note — Raw fruit juice should not be given at the same meal 
with milk. It should be given either one-half hour before or one- 
half hour after such meal. 



102 HEALTHY CHILDREN 



Eighteen to Twenty-four Months 

6:00 to 7:00 a. m. Two ounces of orange juice or 

Pulp of six stewed prunes or 

Two tablespoonfuls baked apple (strained) or 

Two tablespoonfuls pineapple juice. 
7:00 to 8 :00 a. m. Three tablespoonfuls of cereal with milk and a 
small amount of sugar. 

Glass of milk (eight ounces). 

Piece of toast or bread, buttered. 
11:00 a. m. Milk (eight ounces). 

Cracker, zwieback or bread. 
1 :30 to 2 :00 p. m. One article to be selected from each of the 
following groups: 

1. Beef juice, two to four tablespoonfuls, with 

bread. 
Egg, soft boiled, poached or coddled. 
Scraped beef, one tablespoonful. 
Mutton, chicken or beef broth, one cupful. 
Minced chicken, two tablespoonfuls. 
Vegetable soup, one cupful. 
Lamb chop. 

2. Bread, zwieback or cracker. 

3. Boiled rice, small baked potato, spinach, 

well cooked carrots, fresh peas. 

4. Cornstarch pudding with milk, rice pudding, 

baked custard, junket, two tablespoonfuls 
pulp of baked apple or pulp of six prunes. 
5 :30 to 6:00 p. m. Cereal and milk. 

Zwieback or stale bread, buttered. 
Stewed fruits. 
10:00 p. m. Milk (eight ounces). 

Note — Raw fruit juice should not be given at the same meal 
with milk. It should be given either one-half hour before or one- 
half hour after such meal. 

Two to Four Years 

7:00 a. m. Juice of one orange or 

Pulp of six stewed prunes or 

Two tablespoonfuls of baked apple or 

Two tablespoonfuls pineapple juice. 



FOODS AND FEEDING 103 



8:00 a, m. Cereal of medium thickness, four tablespoon- 

fuls with milk and one teaspoonful of sugar. 
Egg, soft boiled, poached or coddled. 
Toast or stale bread, buttered. 
Glass of milk or cup of cocoa. 

10:30 a. m. Glass of milk (eight ounces). 

One slice of bread, cracker or zwieback. 

1:30 p. m. One article each from groups 1, 3, 4 and 5 or 

2, 3, 4 and 5: 

1. Chicken or beef broth, vegetable soup, milk 

soup made with a little potato or celery. 

2. Egg (poached, coddled, boiled or scrambled), 

tablespoonful of minced beefsteak, lamb 
chop, roast beef, broiled steak, chicken, 
fresh broiled or boiled fish. 

3. Baked, boiled, creamed or mashed potato, 

rice, macaroni. 

4. Two tablespoonfuls of fresh or canned 

vegetables such as peas, string beans, 
spinach, asparagus tips, squash, stewed 
celery. All these vegetables should be 
well cooked. 

5. Rice or bread pudding, junket or custard, 

apple sauce or baked apple. Two table- 
spoonfuls of plain vanilla ice cream, once 
a week. 

5:30 p.m. Cereal with milk toast or stale bread, lightly 

buttered. 
Egg, poached, soft boiled or coddled. 
One cup of milk or cocoa made with milk. 
Custard or stewed fruit. 

Note — Raw fruit juice should not be given at the same meal 
with milk. It should be given either one-half hour before or one- 
half hour after such meal. 

In this age group a cupful of milk and bread or a cracker may 
be given in mid-afternoon or at bedtime, if the child seems 
hungry. Give an egg at only one meal a day. 



104 HEALTHY CHILDREN 



Four to Six Years 

7:00 a. m. Juice of one orange or 

Baked apple or 

Stewed prunes. 

(Fresh fruit may be given in season, except raw- 
apples, which should only be eaten later in 
the day. Fresh berries in small amounts may 
be given.) 

Cereal with milk and one teaspoonful of sugar. 

Glass of milk or cup of cocoa, made entirely 
with milk. 

Bread or toast with butter. 

Egg, soft boiled, poached, coddled, scrambled 
or omelette. 

10:30 a. m. Glass of milk (eight ounces) and bread. 

1:30 p. m. Select one article from each of groups 1, 3, 4, 

5, and 6 or 2, 3, 4, 5 and 6: 

1. Chicken, beef or mutton broth, vegetable, 

pea or bean soups or thick milk soups, 
strained before using. 

2. Chicken, lamb, lamb chop, roast beef, 

beefsteak, minced beef, fish broiled, 
boiled or baked, egg poached, soft boiled 
or coddled. 

3. Vegetables in season, except green corn, 

egg plant or raw vegetables such as rad- 
ishes, cucumbers or tomatoes. 

4. Potato, baked, boiled or lightly mashed. 

5. Bread and butter. 

6. Stewed fruit, peaches, prunes, apricots or 

apples, cookies or ginger snaps, plain cake, 
rice, tapioca, cornstarch or bread pud- 
ding, junkets or custards, ice cream (not 
oftener than once a week), jam, jelly, 
honey, dates or figs. 

5:30 p. m. Cereal with milk and sugar or 

Milk toast or 

Thick soup such as pea or cream of celery or 
Egg, coddled, poached, boiled or scrambled. 



FOODS AND FEEDING 105 

Cocoa made with milk, or a glass of milk (eight 

ounces). 
Bread and butter. 
Plain pudding, cookie or ginger snap, stewed 

fruit. 

Note: Raw fruit juice should not be given at the same meal 
with milk. It should be given either a half hour before or a half 
hour after such meal. 

Give an egg at only one meal of the day. 

Diet in Illness 

During illness the amount of food given 
should be reduced. In case of vomiting or 
diarrhoea, it is best to give nothing except 
plain water or milk for the first twelve hours. 
As proper diets vary for different diseases, the 
directions of the physician should be followed 
in every instance, but if the matter is left 
to the family, there are certain principles that 
may be used as a guide. 

In general, liquid or semi-liquid diets are 
advised in every instance where there is a 
high temperature. These may take the form 
of milk, simple milk soups, cereal gruels made 
thin with milk, broths, custards, milk toast, 
junket and ice cream. The sick child usually 
has little or no appetite, therefore the food 
should be served not only at regular intervals 
but it is very necessary that it should be 
served in a tempting manner. Often the 
child who will not drink milk at all from a 
large pitcher and glass may be induced to take 



106 HEALTHY CHILDREN 

it when it is served on an attractive tray and 
the child itself is allowed to pour the milk 
from a small pitcher into a tiny glass. Chil- 
dren are particularly responsive to the dainti- 
ness with which food is served. This is a 
fact which is often not recognized. Investi- 
gation has shown in large numbers of instances 
that children go without breakfast simply 
because it is not served in an appetizing man- 
ner, therefore, where it is necessary to stimu- 
late the appetite, the importance of present- 
ing the food in an attractive manner must 
not be overlooked. 

THE CHILD WHO WILL NOT EAT 

One of the most difficult problems that con- 
front the mother is that of the child who re- 
fuses to eat various kinds of food. Such a 
child may be finicky and eat only certain 
things. Usually there is no appetite at meal 
times. The child will absolutely refuse some 
kinds of food and occasionally will drink 
nothing but milk, or, on the other hand, it 
may refuse milk entirely. There may be an 
appetite between meals but not at meal 
times. Such children have to be coaxed con- 
tinually and tempted to eat by means of 
bribes and presents. Sometimes these chil- 
dren seem to be well nourished ; at other times 
their bad food habits react upon their health 



FOODS AND FEEDING 107 

to such a degree that they are markedly 
undernourished. 

Cases of lack of appetite or refusal to eat 
certain kinds of food are more apt to be found 
among the families of the well-to-do than 
among those who are poor. Children who 
are pampered, over-cared-for and over-in- 
dulged frequently suffer seriously from under- 
nourishment simply because their food habits 
are bad, whereas children whose appetites 
and tastes have not been so constantly 
catered to will frequently get the best value 
from their food, even though the food itself 
may not be all that could be desired. 

Causes of Lack of Appetite, and Results 

Lack of appetite may be caused by the 
onset of acute illness and is common through- 
out any illness, particularly one that is ac- 
companied by a rise in temperature. Such 
loss of appetite, however, is almost always 
sudden in occurrence and the cause is known 
within a day or two. A more chronic lack 
of appetite may be caused by a continued 
state of poor health or as a result of poor 
sanitary surroundings and lack of personal 
hygiene. Children who live in rooms without 
proper ventilation, who do not play enough 
outdoors or get wholesome exercise, almost 
always have a poor appetite. 



108 HEALTHY CHILDREN 

Loss of appetite may be caused by some 
definite physical defects, such as the presence 
of adenoids or enlarged tonsils. Chronic con- 
stipation is a common cause, while decayed 
teeth and aching teeth will not only make a 
child timid about eating but will cause it to 
swallow its food without proper chewing. 
This leads to indigestion and consequent lack 
of a desire for food. Too-long-continued 
reliance upon milk as the chief article of food 
and too much milk in the day's diet are com- 
mon causes of lack of appetite for other foods. 
The great majority of cases where children 
are finicky about their food or refuse to eat 
are simply the results of bad food habits, bad 
training or over-indulgence. 

Types of Poor Appetite 

Generally speaking, any normal child should 
be able to eat any kind of food. There are 
certain exceptions to this general rule, how- 
ever. Some children may have an extreme 
distaste for one or another kind of food, and 
when it is evident that the child refuses to 
eat because of an active dislike, the use of 
this food should not be urged. Marked 
cases of food idiosyncrasy which have been 
referred to elsewhere should also be sufficient 
reason for avoiding the particular kinds of 
food which produce the symptoms. In gen- 



FOODS AND FEEDING 109 

eral, however, the ordinary type of lack of 
appetite or objection to certain kinds of food 
is where the child will not eat any breakfast 
but becomes hungry in the middle of the fore- 
noon and is given something to satisfy its 
appetite. At meal times the child will almost 
invariably refuse some kinds of food and some- 
times will refuse to eat at all. 

Management of Loss of Appetite 

Milk feeding should not be continued be- 
yond the normal weaning age of nine months, 
except upon the special advice of the phy- 
sician in attendance. After nine months the 
child should have less milk, and other foods 
should be added to its dietary. If the milk 
feeding is continued beyond this time the 
child may learn to depend upon it and this 
fact, combined with the excessive amount of 
milk taken, will drive away appetite for other 
food. Improper hygienic surroundings must 
be corrected and the child's personal hygiene 
outlined carefully. Physical defects must be 
corrected and care taken to see that the 
bowels function regularly. If, after all these 
matters have been attended to, the child 
still refuses to eat properly, it is probable that 
the difficulty lies in bad feeding habits. The 
real problem mothers have to meet, therefore, 
is that of the finicky child who will not eat 



110 HEALTHY CHILDREN 

plain, nourishing food, craves sweets and 
requires to have its appetite stimulated. Such 
children commonly eat between meals and 
have candy when they desire it. The question 
of how to bring such children back to the nor- 
mal routine of life is not a medical one but de- 
pends upon the right kind of mother and her 
firmness of purpose. 

The first thing to be done is to establish 
proper feeding habits. The mother must fix 
firmly in her mind the fact that she must not 
waver in her purpose for one moment, that 
if she truly and honestly desires her child to 
be fed properly, she must persist until she 
has accomplished her object. There is ab- 
solutely no danger for the ordinary child who 
is not ill if it goes without food for from 
twenty-four to forty-eight hours, and, further- 
more, every mother should remember that 
appetite is a normal condition and the child 
will eat as soon as it becomes hungry. 

First of all, the meals must be regular. In 
the morning the child should have a whole- 
some, plain breakfast set before it. There 
should be no coaxing to eat; in fact, the best 
method is to have the whole family deliber- 
ately ignore the child and pay no attention 
to whether it is eating or not. If it refuses 
its food, that fact should cause no comment. 
During the morning, however, when the child 



FOODS AND FEEDING 111 

asks for extra food, it must be refused and the 
child should have nothing to eat until the 
noonday meal. At that time a simple din- 
ner should be served. If the child still re- 
fuses to eat, no further notice should be taken 
of the matter, and at supper time the same 
routine should be followed. If the child goes 
without food altogether during the first day, 
there is hardly a chance in the world that it 
will refuse it the second day, and usually one 
twenty-four or forty-eight hour period is all 
that is necessary to make a success of the 
plan, but there must be no letting down of the 
bars afterwards. Once the habit of three 
regular meals a day has been established as 
the proper basis, nothing should be permitted 
to interfere with this routine. 

The rules for teaching children to eat are 
simple, but must be adhered to absolutely: 

1st: The meals must be attractive. A child should not be 
asked to sit down to a slovenly table or a badly prepared 
meal. 

2nd: The meals must be regular. Breakfast, dinner and sup- 
per must be at exactly the same time each day. If this 
is impossible for the rest of the family, it should be made 
possible for the child. 

3rd: The food that the child ought to eat should be placed be- 
fore it. There should be no comment whatever upon 
whether or not it is eaten. 

4th: There must be no eating between meals. 

5th: Candy should not be allowed except as a dessert after the 
principal meal of the day. 

6th: The food should be varied. Children dislike monotony 
in food even more than adults do. 



112 HEALTHY CHILDREN 



7th: The child should not be required to eat any food that it 
actually dislikes, but before this is determined upon, a 
trial should be made. 

8th: A child should not be allowed to eat food that makes it 
ill. 

9th: From two to six years of age, one and a half pints of milk 
a day is sufficient. Part of this should be given plain 
and part in the form of cocoa, milk soups, custards, ice 
cream, junkets or cooked with vegetables. 

10th: The mother must remember that upon her, not upon the 
child, depends the success or failure of the effort to estab- 
lish proper food habits, and she must remember, first, 
last and all the time that if the cause of the loss of ap- 
petite is ill-health, the condition must be treated, but if 
the child is in normal health it will make no difference if 
it goes without food for one or two days, and that as soon 
as it is hungry, nature will assert itself, and the child 
will eat. 



CHAPTER V 

MALNUTRITION 

Malnutrition is the most serious underlying 
cause of disease. It results in lack of resistance 
in the individual. Undernourished children 
are particularly susceptible to infection. Be- 
cause the lack of resistance predisposes to 
disease and because disease frequently re- 
sults in lowered vitality, it is sometimes diffi- 
cult to discover whether the malnutrition 
is the underlying cause of the disease or 
whether the disease is direct cause of the mal- 
nutrition. It is necessary for children to be 
well nourished if they are to resist disease and 
grow up with a normal physique. 

Malnutrition in childhood is alarmingly 
widespread. Statistics show that from 
twenty to twenty-five per cent of all children 
in the United States, not only in the cities 
but in the rural districts as well, are seriously 
undernourished. Its occurrence in childhood 
and during the period of growth interferes 
with the proper development of the body and 
the bodily organs and this retarded develop- 
ment makes such a lasting impression upon 
the child's whole physique that it is rare that 
full health is regained in later life. (See illus- 
tration opposite page 183.) 

113 



114 HEALTHY CHILDREN 

Causes 

It is a popular impression that malnu- 
trition is caused by lack of food. There is a 
difference between chronic undernourishment 
and starvation. While lack of food un- 
doubtedly will cause a type of undernourish- 
ment, the common cause is not insufficient 
food as much as it is the wrong kind of food, 
and irregular feeding. Therefore, under- 
nourishment is found among the rich as well 
as among the poor, for there is little differ- 
ence in the results between the pampered, 
over-indulged child of well-to-do parents who 
is fed largely on the wrong kind of food, such as 
sweets and pastries, and the poor child who 
cannot get the proper food to eat and who 
buys cheap candies and inferior ice cream 
with the few pennies at its disposal. 

While wrong feeding is the basis of a large 
number of cases of malnutrition, the fact must 
not be overlooked that undernourishment in 
childhood may result from undernourishment 
in infancy, due to lack of proper prenatal care 
or to the acute digestive diseases during the 
first year of life. Malnutrition is due also 
to insanitary surroundings, improper home 
environment and disregard of personal hy- 
giene. Lack of ventilation in sleeping rooms 
and too much play indoors will result not only 



MALNUTRITION 115 

in lack of appetite but also in definite dis- 
turbance of the nutrition of the body. In- 
sufficient rest, interrupted or too short sleep- 
ing hours, late bedtime, nervous excitement, 
evenings spent in close, ill-ventilated rooms 
watching exciting moving picture shows, and 
over-fatigue of any type are direct causes of 
malnutrition. Physical defects of all kinds 
will interfere with the proper nourishment of 
the body, the most prominent of these being 
adenoids, enlarged tonsils, defective vision 
and decayed teeth. 

Symptoms 

The most common method of detecting mal- 
nutrition is by determining the rate of growth 
of the child and the relation of its weight to 
its height. The principle is generally ac- 
cepted that any child who is ten per cent 
below the normal average weight for its 
height is undernourished. However, owing 
to certain racial and family characteristics, 
this is not always a true test, consequently 
other symptoms have to be looked for and 
are readily observable. 

The undernourished child has a character- 
istic appearance. Usually the face has a 
drawn, tired expression. There are apt to 
be dark circles under the eyes, the skin may 
be pale or of a dusky color, the child's whole 



\ 

\ 



116 HEALTHY CHILDREN 

body droops, the shoulders are pushed for- 
ward, chest sunken, and the shoulder blades 
in the back are apt to protrude. There may 
or may not be some curvature of the spine, but 
usually, in standing, the child throws most of 
its weight on one foot, so that it leans to one 
side. Almost always there is bad posture 
with prominent abdomen and what is known 
as a "slouchy" attitude. The muscles are 
soft and flabby, while the hair usually loses 
its lustre and is dry and brittle. Other 
symptoms which have to do with the con- 
dition of the child may be observed readily. 
Frequently there is excessive nervousness, 
with disturbed sleep. There may be twitch- 
ing of the muscles. The appetite is apt to 
be diminished, and the child shows marked 
preference for particular types of food, re- 
fusing all others. Undernourished children 
rarely show any marked vitality. They act 
as if they were nervously exhausted, do not 
want to play and are unwilling to make any 
effort. There is a marked amount of lassi- 
tude and fatigue. Any action requires an 
amount of initiative they are unable to sum- 
mon. Such children are constantly subject 
to disease, particularly those of an infectious 
nature. 



MALNUTRITION 117 

Care and Treatment 

In order to have effective treatment, it is 
necessary to interest the child in its own prog- 
ress. In school children this can be done by 
means of competition between the various 
members of the class, to see which will pro- 
gress most rapidly in weight and general 
health. With children of preschool age, com- 
petition is not so easy to bring about, but even 
with very young children the sense of per- 
sonal pride may be brought out in many in- 
stances. Each child should have its height 
measured at least twice a year and should 
be weighed each month. A personal weight 
chart, similar to the one illustrated else- 
where in this book, should be used to make 
an individual record of each case. Progress 
is the thing to be desired, therefore, the weight 
curve must have an upward tendency. Any 
loss of weight or stationary weight for a 
period longer than one month shows that the 
type of care given is not suitable. 

All insanitary conditions must be eliminated 
and careful attention paid to the personal 
hygiene of the child. Many cases of mal- 
nutrition have been cured by having the child 
sleep outdoors or in a room w T ith the windows 
wide open. Other cases have responded im- 
mediately to a course of treatment which in- 



118 HEALTHY CHILDREN 

eluded a midday nap or enforced rest for at 
least two hours a day. Play may have to be 
restricted to a great extent, particularly if 
the child is over-active and emotional, and 
throws itself with all of its energy into every 
game. Physical defects found to exist must 
be corrected. Late hours and attendance at 
the movies must be avoided. The child 
should have from ten to twelve hours sleep 
at night and two hours rest in the daytime. 
Meals must be regular and consist of plain, 
wholesome food. Feeding between meals is 
not essential unless the child is not gaining. 
Then an additional meal of crackers and milk 
or cocoa may be given in the middle of the 
forenoon or afternoon and again at night, but 
this should not be allowed to take the place 
of the regular meals, and if it interferes with a 
proper appetite at mealtimes, it should be 
discontinued . Occasionally, undernourished 
children may have the full value of their food 
more apparent if they are given five small, 
regular meals a day rather than three hearty 
ones. 

There should be a rest period of a half to 
one hour after each meal during which time 
the child should lie down out-of-doors or in a 
well ventilated room, and remain perfectly 
quiet. Sweets between meals should be for- 
bidden. There is no harm in the sweets 



MALNUTRITION 119 

themselves; the difficulty is that they usually 
take away the child's small appetite and make 
it impossible for it to eat the nourishing diet 
it needs. Plain candy may be given after 
meals, but not at any other time. In the 
dietary, emphasis should be placed upon a full 
pint and a half of milk a day, plenty of cereals, 
fresh vegetables, particularly the leafy types, 
and fruits. Children of preschool age should 
never, under any circumstances, be allowed to 
drink either coffee or tea. This is particularly 
true in regard to the undernourished child. 
There is another class of undernourished 
children that does not respond to any of these 
types of care. Usually, detailed study will 
show that the difficulty is with the emotional 
life of the child. There are instances where 
children are undernourished, pale and lacking 
in proper development and the cause is simply 
the excessive nervous reaction of the child to a 
disorganized family life. Parental neglect, 
family discord and an unhappy environment 
result inevitably in worry and unhappiness to 
children. Even without harsh punishments, 
the child can suffer intensely from a sense of 
general lack of harmony in its environment. 
Such children are shy and introspective, and 
inevitably become undernourished. Removal 
of such a child to a proper environment will 
result at once in marked improvement. 




HEALTHY CHILDREN 



The proper way to deal with malnutrition, 
therefore, is first to find the cause, that is, the 
place where the child's life is departing from 
the normal, and then to do everything pos- 
sible to remove the discordant or improper 
environment or factors and place the child 
in a position where it may lead a normal, 
wholesome life. 



CHAPTER VI 

THE NERVOUS CHILD 

Prevention and care of nervous diseases oc- 
curring during childhood are important for 
two reasons: First, because the nervous child 
suffers intensely from its affliction and second, 
because nearly every type of nervousness in 
adult life can be traced to its beginning in 
childhood. Anyone who has suffered from a 
nervous disorder knows that such a handi- 
cap stands in the way of normal mental and 
physical development and that it is likely to 
make life almost unbearable at times. Much 
of this suffering during adult life is unnecessary 
and can be prevented in childhood. Also, the 
methods of correcting nervousness after it has 
been established are much more simple and 
effective in early life than they are later. 

The nervous system of a child is exceedingly 
complex. It is unstable and easily affected. 
Prevention of nervous disorders in childhood 
really begins during the prenatal period, for 
if the expectant mother is neglected and poorly 
nourished during the months before the baby 
comes, the probabilities are that the child will 
suffer from lack of vitality and that it will 
be affected by nervous and emotional dis- 
orders. This is one of the reasons why proper 
prenatal care is so essential. 

121 



122 HEALTHY CHILDREN 

Causes 

The causes of nervousness generally may 
be traced to the period of earliest infancy. 
Few young babies are naturally nervous, and 
almost always the trouble is with the parents. 
Fathers and mothers who are nervous, ir- 
ritable, over-anxious, over-indulgent or sub- 
ject to outbursts of temper or irritability, will 
nearly always have nervous children. Even 
in earliest infancy, the baby is extremely 
susceptible to its environment. If the father, 
mother, nurse or any other member of the 
family who comes into intimate, daily con- 
tact with the baby, is nervous and temper- 
amentally highstrung, the condition will react 
upon the child. 

The causes of nervousness in infancy as well 
as in early childhood are either physical or 
emotional. The physical causes are mainly 
indigestion, anemia or malnutrition. After 
the child is over two years of age, other physi- 
cal causes such as defective eyesight, with 
resultant eyestrain, adenoid growth and im- 
pacted or decayed and painful teeth, may be 
considered predisposing causes. The emo- 
tional causes, however, seem to be the more 
important. Even before they are able to 
express themselves, children are extremely 
sensitive to emotional reactions. Sudden 



THE NERVOUS CHILD 123 

fright and unexpected noises, being awakened 
suddenly, violent jouncing up and down, or 
being danced about, too little sleep, late bed- 
time, over-handling and over-fatigue, all lay 
the foundation for nervous disorders. Lack 
of understanding of the child and consequent 
nagging and arbitrary rules tend toward the 
formation of the habit of self-suppression in 
early life, and to emotional outbursts later. 
Children are essentially imaginative beings. 
They live in a world of their own. Their 
fears, sorrows and disappointments are far 
more keenly felt and more real than any we 
know in adult life. The child lives in the pres- 
ent, while the adult has the future in view, 
therefore any lack of understanding of the 
child's fears, or, what is far more criminal, the 
cultivation of such fears, often has serious and 
far-reaching effects upon the child's whole life. 
Parents are to blame if they suppress the 
child's natural instincts. Particular empha- 
sis should be placed upon fear as a cause of 
nervousness in later life. Many cases of 
nervousness have their starting point in a 
sudden fright or in a story told to frighten 
a child. The harm that may be done by 
threatening a child that some terrible thing 
will happen to it is almost beyond comprehen- 
sion. In the case of the more serious nervous 
diseases, definite causes can be traced, and 



124 HEALTHY CHILDREN 

these will be considered later, but in the case 
of the ordinary functional nervous disorders, 
or what is commonly called "nervousness," 
it is deplorably true that the fault is usually 
with the child's surroundings rather than with 
the child itself. Fathers and mothers must 
realize that it is largely within their power to 
determine whether or not a child will be 
nervous or calm and well-poised. 

Symptoms of Nervousness 

The symptoms of nervousness in children 
or in adults are many and varied, and not all 
of them occur in each instance. Each case 
must be judged by itself. In general, how- 
ever, there are two main types of the nervous 
child to be considered, but it must be remem- 
bered that symptoms of both types may occur 
in the same child. The first type is that of the 
over-excitable child. Such a child may be 
robust and well nourished, or it may be anemic 
and show signs of undernourishment. The 
most predominant symptoms are those which 
have to do with the emotional side of life. 
Such children are excitable and given to sud- 
den fits of anger or temper. They are ex- 
tremely irritable and have frequent outbursts 
of loud, shrieking laughter. There is a con- 
stant hunger for excitement. In their play 
they are apt to be quarrelsome and dicta- 



THE NERVOUS CHILD 125 

torial and always want to assume leadership. 
Such children are apt to hold themselves with 
muscles rigid. They are over-anxious for 
praise and will do almost anything to gain it. 
They cannot stand blame. Sometimes they 
have a tendency to be cruel, especially to 
animals, and they may be very deceitful. 

The second type is that of the shy, emotional 
child. This type shuns people and does not 
want to play or associate with other children. 
They are easily startled or shocked by any 
sudden noise. They may be morose and ec- 
centric in their behavior. Sleep is often dis- 
turbed. Such children may be peevish and 
irritable, but usually their predominating 
symptoms are those of over-shyness. They 
are apt to hesitate and find it difficult to 
adjust themselves to their environment. They 
do not care to play with other children, and 
often are either afraid or unable to recite in 
school. Such children usually lack decision, 
and they are rarely, if ever, able to decide 
what they want to do or to take any definite 
action. Usually their fear is extreme. They 
distrust themselves and are abnormally afraid 
of the dark and of animals. They find diffi- 
culty in getting to sleep at night, and do not 
want to sleep alone. The shy, reserved child 
has day dreams, preferring to be by itself and 
indulge its imagination. Such children rarely 



126 HEALTHY CHILDREN 

tell the results of these day dreams or the 
things they think about. We all have en- 
countered the nervous child who constantly 
makes up long stories about occurrences that 
never have happened, but which, neverthe- 
less, are very real to the child. 

Nervous children may be either bright or 
dull. The excitable type is apt to be over- 
precocious. Frequently they are extremely 
brilliant along certain lines, and it is not 
unusual to have such children considered as 
"prodigies." Parents constantly put them 
forward so that they may show off their bril- 
liancy. However, their powers of endurance 
are poor and while they may readily excel 
in some one direction, they are rarely able to 
excel on all points. They put into their play 
or other activities every particle of strength 
they have, holding nothing in reserve. 

Prevention and Treatment 

Prevention of nervousness should begin in 
the prenatal period. Even when the baby 
is born in normal, healthy condition, however, 
there should be no relaxation of preventive 
measures, and they must be continued 
throughout infancy. Mothers must realize 
how fragile and unstable the baby's nervous 
system is. The ordinary noises of the house 
need not be stilled; in fact, it is much better 



THE NERVOUS CHILD 127 

to have the baby grow accustomed to normal 
noises from the beginning. Sudden fright and 
unexpected noises or sudden awakening of the 
baby by means of unusual sounds or move- 
ments to attract its attention are extremely 
harmful. The habit of dancing babies up and 
dow r n and awakening them from sound sleep 
for any purpose other than feeding, must be 
avoided. The proper routine of the child's 
life is essential as a preventive of nervousness. 
The hours of sleep and regularity of the daily 
routine are immensely important in this re- 
gard. Over-handling should be avoided. All 
possible physical causes of nervousness must 
be removed. In little babies, improving the 
nutrition and preventing the occurrence of 
physical defects by means of fresh air and 
general hygiene are of importance and these 
measures must be continued as the child 
grows older. Eyestrain, decayed teeth and 
adenoid growths should not be allowed to de- 
velop. Sometimes worms are an exciting 
cause, although it is usually easy to determine 
this point as the nervousness lasts only as 
long as the worms are present. 

If possible, nervous children should sleep 
outdoors. At all events, they should be in 
the fresh air as much as possible. Rest is par- 
ticularly important. The nervous child should 
have not only its full number of hours of rest at 



128 HEALTHY CHILDREN 

night, but should be required to take at least 
one nap during the daytime. Normal exer- 
cise should be encouraged, but over-stimulat- 
ing and over-exciting play is harmful. It 
should be unnecessary to state that a child 
under six years of age should not be taken 
to the movies. The influence of moving 
picture shows on children may be of two 
kinds — the physical effects of late hours, bad 
air and overcrowding are obvious. In ad- 
dition, the emotional effects must be con- 
sidered. While some of the moving pictures 
have much to commend them and are adapted 
for children, the vast majority are unsuited 
for the young, impressionable child. When 
the over-stimulation of the emotions is added 
to the late hours and bad environment, there 
can be no question whatever that the child 
under six years of age should not be allowed 
to see the general type of moving pictures 
or to be in any place where such pictures are 
shown. Late hours must be avoided in any 
case. 

Mothers and fathers must learn that they 
have much to be responsible for in the pro- 
duction of nervousness in their children. The 
child with a normal nervous system and calm, 
well-poised attitude toward life, reflects its 
home environment. The child should never 
be nagged. Harsh and arbitrary rules simply 



THE NERVOUS CHILD 129 

incite resentment in the child. If its emotions 
are not expressed at the time, they are felt 
nevertheless and when they are suppressed 
they are apt to be much more destructive to 
the child's future well-being than if they re- 
sulted at the moment in outbursts of temper 
or in obstinacy and refusal to obey the orders 
or commands given. 

The question of preventing nervousness is 
strongly allied to the whole matter of dis- 
cipline during childhood. Two things must 
be remembered : first, that the nervous system 
of the young child is very unstable; and, 
second, that all children are imaginative. 
The over-excitable child needs a particularly 
calm environment and wise direction of its 
exuberance and activity along proper lines. 
The imagination of such children should never 
be suppressed or laughed at. They should 
never be accused of lying or trying to deceive 
when they are simply expressing a l 'flight of 
fancy." It is not difficult to distinguish be- 
tween a direct lie and a ' 'flight of fancy." 
When the child comes running in and says 
that it has met a great big bear on the road, 
there is no intention to deceive, for to the 
child's imagination some little dog has assumed 
the aspect of a bear and the story the child tells 
is very real and vivid to it. Such a child 
should have the truth explained but this 



130 HEALTHY CHILDREN 

should be done in a tactful way that will not 
create antagonism. Children's fancies are 
only too easily suppressed and the tendency 
to mold all children into a common type, and 
to suppress their instincts and imagination 
and self-expression, results not only in much 
unhappiness to the child at the time but often 
in distinct loss of the power of expression that 
it might be able to display in later life. 

Play should not be boisterous or quarrel- 
some. It should be properly directed and 
should have a result. Children like to do 
things with their hands, and constructive 
play can be arranged just as easily as the 
destructive kind. Children love competitive 
games for this reason. They like to play ball 
or to make mud pies or play house or do any- 
thing of that kind that appeals to their 
imagination and has a result. Aimless play 
or play with toys that are already made and 
that require no aid from the child is unsatis- 
factory and may even be harmful. Children 
should be taught to make their own toys and 
to be satisfied with the simplest equipment pos- 
sible. Over-indulgence is responsible for far 
more nervousness than lack of indulgence in 
this respect. The child who is always forced 
to provide its own amusements and to make 
its own playthings in all probability will have 
a far finer nervous temperament and be better 



THE NERVOUS CHILD 131 

able to meet the world on its own terms than 
the child who has had everything done for it, 
and who has never had an opportunity to exer- 
cise its constructive ability. Creative imagin- 
ation in children should be encouraged. If it is 
not allowed its normal outlet, it may result in 
much harm and lead the natural impulses 
to take the form of introspection, shyness and 
the breaking down of character, so that the 
child becomes indecisive and morbid. 

Nervous children should never be punished, 
and rarely, if ever, should they be blamed. 
If they have been taught to fear anything, 
every effort should be made to reason with 
them calmly and to explain that the thing or 
occurrence they fear should not be feared. 
Children are susceptible to reason at an un- 
usually early age. There should be no arbi- 
trary "do's" and "don'ts," but as soon as the 
child is old enough to talk, it has a right to 
know why it is required to do certain things. 
On the other hand, there must be no wavering 
or lack of firmness on the part of the parents. 
Once the child has been told to do a certain 
thing and the reason therefor has been ex- 
plained, instant obedience must be expected, 
but nothing unusual or arbitrary should be 
asked for, nor should the child be required to 
do things merely to vent the displeasure or 
temper of the parents. The tasks that are 



132 HEALTHY CHILDREN 

given the child to do should fit its capacity. 
The relation of the parents to the child should 
be one with the definite object of cultivating 
its self-reliance and making it a responsible, 
intelligent human being. This cannot be done 
if the father and mother continue to make the 
child feel its dependence. Every new human 
being has a distinct right to a life of its own, 
and while the early years of that life must 
necessarily be dependent upon someone else 
for guidance, the object of that guidance 
should not be to make the dependence con- 
tinue but rather to build up in the child the 
ability to make its own decisions, to tell the 
difference between right and wrong, be pre- 
pared to take a proper attitude toward life, 
respect the rights of others and to be able to 
adjust itself to its environment in later life. 
Inability to get on with people or to meet 
events as they occur during life is probably 
the cause of more real unhappiness than any 
other thing that can occur to us. 

While emphasis has been laid on the harm- 
fulness of nagging, punishment and arbitrary 
action, it must not be forgotten that almost 
equal harm may be done by over-indulgence. 
The spoiled, pampered child is not only apt 
to be extremely nervous but usually is unable 
to adjust itself to its environment and may 
lead a life of great unhappiness. The over- 



THE NERVOUS CHILD 133 

indulged child is far more apt to become the 
neurotic of later life than the child who has 
had difficulties to overcome. 

Neurasthenia, nervous breakdown, hyster- 
ical attacks and the lack of self-confidence that 
leads to inability to get on in the world nearly 
always are the result of wrong training dur- 
ing early child life. 

CHOREA (ST. VITUS DANCE) 

Chorea is not commonly found in children 
under five years of age. Usually it is associ- 
ated with the early years of school life and 
there has been an impression that the nervous 
strain of school life is one of the predisposing 
causes. Probably this is true in part, never- 
theless it is unlikely that a child who is per- 
fectly normal on entering school will develop 
so severe a nervous condition simply as a 
result of school routine or school pressure. 
As the basis of all nervous diseases is laid in 
early life, we must consider that the main 
predisposing causes of chorea occur during the 
preschool age. 

Causes 

Chorea may be due to a variety of causes. 
Sometimes it is exceedingly difficult to trace 
any one thing that may be considered the 
main predisposing factor. In general, how- 
ever, prolonged nervous fatigue or over-ex- 



134 HEALTHYCHILDREN 

citement during the first few years of life, 
long continued undernourishment with anemia 
and chronic intestinal indigestion, are the 
common predisposing causes. The possibil- 
ity of chorea being a manifestation of rheu- 
matism must not be overlooked. 

Symptoms 

The symptoms of chorea are quite character- 
istic, and once seen, they are not easily for- 
gotten. Usually they begin with a marked 
amount of restlessness, the child is unable to 
sit still, there is constant shuffling of the feet 
in walking about, and it is impossible to co- 
ordinate the muscles or guide the hands and 
feet in the right direction. There is marked 
inability to control the movements of the arms 
or legs. The child may reach for an article 
on the table but the hand will not touch the 
article but will grope around before the child 
can make it grasp the thing that is sought. 
Children will often knock things off the table 
when trying to grasp them. The movements 
seem to be extraordinarily clumsy and the 
child is quite unable to control them. There 
is apt to be marked twitching of the face, and 
occasionally grinding of the teeth. The head 
jerks convulsively from side to side and some- 
times the whole body will move with a series 
of loose, more or less convulsive gestures. 



THE NERVOUS CHILD 135 

The constant motion of every part of the body, 
with the twitching, jerking and uncoordi- 
nated muscular efforts, is characteristic of 
chorea. There are, in addition, certain emo- 
tional disturbances. The child usually mani- 
fests marked irritability of temper, is unable 
to control its emotions and will laugh or shriek 
loudly and have outbursts of crying when 
there is little or no cause. 

Prevention 

Prevention of chorea consists in prevention 
of nervous diseases in general. The child 
should be kept in as good physical condition 
as possible, and if there is the slightest ten- 
dency toward nervousness, the hygienic sur- 
roundings must be of the best. Such children 
should not be sent to school at an early age 
but should be supervised carefully until all 
emotional strain is relieved before being al- 
lowed to engage in competitive effort in school 
work with other children. Physical defects 
should be remedied, if they are present, and 
every effort made to build up the child's nu- 
trition. Normal, wholesome but limited ex- 
ercise, with plenty of fresh air and sleep, is 
essential. 

Treatment 

When this disease has already occurred, the 
best treatment is to put the child to bed and 



136 HEALTHY CHILDREN 

keep it as quiet as possible. Medical care 
is essential, owing to the possible effect that 
chorea may have upon the heart, also for the 
prompt cure of the disease itself. The doctor 
should be summoned without delay, therefore, 
if any unusual twitching or convulsive move- 
ments are noticed in the child. 

HABIT SPASM 

Habit spasms have a certain resemblance 
to chorea, as far as the symptoms are con- 
cerned. The characteristic difference that 
may be noted, however, is that in habit spasms 
the convulsive movements are always around 
the face, tongue or head, that is, they are 
above the neck, while in chorea the entire 
body is involved. 

Causes 

Habit spasms usually occur in nervous 
children. There is no definite organic cause, 
but they are more apt to occur in children who 
are undernourished and who are suffering from 
some form of physical defect. They are more 
common among children of school age because 
they are in a sense a form of imitation. If one 
child in a class-room is affected, within a short 
time a large number of others will begin to 
have similar convulsive movements of the 
head, face and neck. 



THE NERVOUS CHILD 137 

Symptoms 

The child will make sudden grimaces, 
twitching the mouth, closing the eyes, with a 
pronounced frown, show the teeth, jerk the 
head from side to side and there may even 
be twitching of the individual muscles of the 
face. 

Prevention 

Prevention of habit spasms consists in main- 
tenance of good health in the child and remov- 
ing all causes of nervous diseases. 

Treatment 

Children found to have habit spasms should 
be kept entirely isolated so that imitation of 
the condition may not be taken up by other 
children. Complete rest and the estab- 
lishment of normal habits are necessary. 
The disease, may tend to become chronic and 
if the condition persists medical advice should 
be obtained. 



CHAPTER VII 

COMMON DISEASES OF CHILDHOOD 

COUGHS AND COLDS 

Colds are one of the commonest ills of 
childhood. They range in severity from the 
simple running of the nose, with perhaps slight 
congestion of the eyes, to a condition known 
as "bronchitis," where there is a great deal of 
constitutional disturbance, a cough and the 
presence of fever. It is always possible for 
a slight cold to become a more severe one; 
therefore a cold, however simple it may seem 
to be, should never be neglected. Some chil- 
dren seem to have a predisposition to colds, 
and from fall until spring are scarcely ever 
free from excessive discharge of mucus from 
the nose. While the treatment of colds is of 
great importance, their prevention is more so, 
and everything possible should be done to see 
that the child is put in such healthy condition 
and lives in such a normal manner that it will 
not "take cold." 

Causes 

Anything that lowers bodily resistance or 
vitality predisposes to disease, and children 
who are not robust are the ones who fall 
easiest victims. Such children are easily 

138 



COMMON DISEASES OF CHILDHOOD 139 

weakened by attacks of colds and bronchitis, 
and as a result they seem less healthy. In 
fact, it is sometimes difficult to tell whether 
the colds are the cause of the lowered vitality 
of the child or the lowered vitality is the cause 
of the colds. Such a vicious circle must be 
broken into and the best way is to begin to 
fortify the child during babyhood. 

Prevention 

Unless the child reacts well, cold baths are 
not advisable, but at the age of one year it is 
good practice to give a quick, cold sponge 
over the neck and shoulders of the child im- 
mediately after the warm bath. The cold 
bathing of the neck and shoulders must be 
practiced every morning and should be con- 
tinued not only throughout childhood, but as 
a permanent habit. It is one of the best 
preventives of cold that we know. 

Proper feeding also is a safeguard against 
colds, as it is against all diseases. The cloth- 
ing of children will be considered' in another 
chapter, but may be mentioned here as it has a 
distinct bearing upon the production of colds. 
Probably there is no class of children who "take 
cold" more readily than those who are habit- 
ually overclothed. After they have been 
playing in warm rooms, or even outdoors, and 
have become superheated, they sit down to 



140 HEALTHY CHILDREN 

cool off, with resultant chill to the body. It 
is probable that an excessive amount of 
clothing causes more illness than too little 
clothing, although a child who is habitually 
cold because of insufficient clothing and who 
always has cold hands and blue lips needs 
equally vigorous attention. The happy mean 
lies in dressing children when indoors in winter 
in the same weight clothing they wear in mild 
summer weather. When outdoors, the differ- 
ence should be made up by the thickness of 
the outer wraps. Wool underclothing, by 
inducing perspiration, is not as healthful as 
cotton or a mixture of cotton and wool or 
silk and wool. 

Overheated and badly ventilated rooms are 
also productive of colds. Fresh air and good 
ventilation are the best preventives. While 
certain types of head colds are due merely 
to congestion, others are due to direct in- 
fection and for this reason a person suffering 
from cold should not come into intimate 
contact with other people, particularly chil- 
dren. A child should never use a pocket 
handkerchief belonging to anyone else, and 
everyone, during the act of coughing or sneez- 
ing, should hold a pocket handkerchief over 
the mouth. The infection is probably carried 
in little droplets that come from the mouth 
during the act of coughing or sneezing. If 



COMMON DISEASES OF CHILDHOOD 141 

anyone happens to be near enough, the breath- 
ing in of these particles may cause a cold. 
They do not, however, float in the air unless 
it is in the dust. For this reason children, 
particularly very young ones, should not be 
taken outdoors on very windy or dusty days, 
nor should they be permitted to remain in 
rooms that are being swept or dusted. This 
is one of the reasons why the child's room 
should not have a carpet, but rather rugs that 
may be taken out easily, and a hardwood 
floor that may be kept clean. Other common 
means of "taking cold" are sitting in drafts, 
playing on the floor in a room that is not 
properly heated, wearing wet stockings or 
shoes and sudden changes in temperature 
without corresponding changes in clothing. 

Treatment of Colds 

If a cold does occur, there are various 
methods of treating it which will probably 
give relief and which will usually stop it within 
a short time. First of all, the child should be 
given a good cathartic, preferably a table- 
spoonful of castor oil. For a day or two the 
diet should be light and readily digestible, 
consisting of milk, cocoa, cereals, custards, 
milk toast, eggs and well-baked white po- 
tatoes. If the child is very hungry, additional 
food in the shape of vegetables may be added. 



142 HEALTHY CHILDREN 

If there is a tendency toward a cough, the 
neck and chest may be rubbed well twice a 
day with camphorated oil. The rubbing is 
really the valuable part of this treatment and 
should be carried on until the skin shows a 
healthy glow. If there is any distinct cough, 
with rise in temperature above one hundred 
degrees, a mustard plaster or flaxseed poultice 
should be placed on the chest. If the nose 
is stopped up, a little white vaseline inserted 
gently into the nostrils will give some relief. 
Nasal sprays or douches should not be given 
by anyone who is not thoroughly trained, as 
much harm may be done when they are given 
carelessly. 

One of the quickest means of relief for any 
obstinate cough, or in cases where the child 
has lost its voice because of congestion of the 
larynx, is the use of the so-called "croup 
kettle." If one is not available, an excellent 
substitute may be made by taking an ordi- 
nary pitcher, filling it with boiling water, and 
putting into it compound tincture of benzoin 
in the proportion of one teaspoonful to a pint 
of water. Then a towel should be placed over 
the top of the pitcher, leaving a small opening 
at the lip. The child should be instructed to 
breathe deeply of this steam while the pitcher 
is held close to its face. The best time for 
this steaming is while the child is in bed, 



COMMON DISEASES OF CHILDHOOD 143 

wrapped up warmly, and later exposure to 
change of temperature should be avoided. 

One of the simplest medicines that may be 
Used is brown mixture, which may be bought 
at any drug store. It can be given in half- 
teaspoonful doses every three hours to a child 
of one year, and in teaspoonful doses every 
three hours to a child of six years. 

If the simple measures outlined here do 
not suffice, or if there is any rise in temper- 
ature above one hundred degrees, a physician 
should be called. 

If a cold tends to become chronic, it is 
probable that there is some local congestion 
or irritation in the nose or throat, and an 
examination should be made by a physician 
to determine if there are adenoids or enlarged 
tonsils present. Each case should be judged 
individually but if the adenoids or enlarged 
tonsils are interfering with respiration, or if, 
in the opinion of the physician, they are the 
cause of the chronic colds, their removal is 
advised. 

CROUP 

Croup is an acute spasm of the larynx, ac- 
companied by a harsh, brassy cough, noisy 
and difficult breathing, and occasionally by 
signs of partial suffocation. It is not common 
in young babies, rarely appearing before six 



144 HEALTHY CHILDREN 

months of age. The vast majority of cases 
occur when the child is from three to six years 
of age. There seems to exist in some children 
a predisposition to croup, which may be a 
family trait. If there is one attack, there are 
apt to be others. Sometimes the attacks 
occur three or four nights in succession; again, 
there may be a long interval between them. 

Cause 

The immediate exciting cause of croup seems 
to be exposure to cold or some form of in- 
digestion. Large adenoids and hypertro- 
phied tonsils are often predisposing causes. 

Symptoms 

During the day the child may exhibit some 
slight difficulty in breathing and older chil- 
dren may have a hoarse, rather hollow and 
barking cough. This becomes increasingly 
worse toward evening, although the child may 
finally go to sleep. The attack itself gener- 
ally comes on about midnight. The child 
awakens suddenly, shows great difficulty in 
breathing, with loud, noisy inspirations, a 
characteristic sound which, once heard, is 
rarely forgotten. The child appears to be 
in great distress. The lips may be blue and 
sometimes there seems to be imminent danger 
of suffocation. The pulse is rapid; occasion- 



COMMON DISEASES OF CHILDHOOD 145 

ally there is slight fever, although the temper- 
ature rarely goes above one hundred two 
degrees. Sometimes the child is quite pros- 
trated, but it must be remembered that this 
disease is never fatal, although it is always 
alarming. After the attack subsides, the 
child usually falls into a refreshing sleep and 
seems quite well again the next day. There may 
be recurrent attacks of croup for two or three 
nights in succession, then they may stop for 
weeks, or even months. 

Prevention 

A child with a tendency to croup should 
be kept in the open air as much as possible. 
If it can be accustomed to cold bathing, so 
much the better. In any event, the neck 
and chest should be sponged with cold water 
night and morning. If adenoids and enlarged 
tonsils are present, t heir removal is advised. 
As digestive disturbances often cause croup, 
care must be taken to see that all food 
the child eats is readily digestible. In in- 
fants, too rich milk or too frequent feeding 
may be the cause, and the feeding interval 
should be lengthened and the milk diluted. 
For older children, tonic treatment may be 
necessary. 



146 HEALTHY CHILDREN 

Treatment 

When an attack occurs, the best remedy is 
syrup of ipecac. This may be given in doses 
of thirty drops every fifteen minutes for a baby 
from six months to a year old, and one-half 
to one teaspoonful every ten to fifteen minutes 
for a child of two years. The doses should be 
repeated until vomiting occurs. If vomiting 
does not occur after two or three doses, the 
child should be given a teaspoonful of white 
vaseline or two teaspoonfuls of goose grease. 
Hot flaxseed poultices or hot fomentations 
should be placed around the child's neck. 
If there is much difficulty in breathing a croup 
kettle should be used. If a regular croup 
kettle is not available, an ordinary tea kettle 
may be made to serve the purpose. It should 
be two-thirds full of water, which must be 
boiling vigorously when the kettle is taken 
from the stove. It should then be placed on 
a chair close to the bed, and a canopy ar- 
ranged over the bed. This may be done by 
raising an umbrella and draping sheets over 
it so that the child is under a tent. The spout 
of the kettle is then inserted through an open- 
ing in the sheet and the child allowed to 
breathe the moist and steaming air. Such 
treatment as this usually loosens the cough 
and if vomiting occurs it almost invariably 



COMMON DISEASES OF CHILDHOOD 147 

relieves the spasm. If the attack recurs dur- 
ing the night, the treatment must be repeated. 
The next day the child should be kept in bed 
and it is advisable to give the syrup of ipecac 
in five-drop doses every two hours during the 
daytime in order to relax the spasm of the 
larynx. 

ENLARGED GLANDS 

Enlarged glands, usually located in the neck, 
are fairly common in childhood, particularly 
in undernourished children and in those who 
are suffering from some degree of infection. 
The terms " strumous' ' and " scrofulous* ' were 
formerly used to describe such a condition, 
but they have very little meaning in them- 
selves and it is more exact to consider the 
real causes which lead up to the presence of 
enlarged glands. 

The glands of the neck are situated mainly 
in three localities : a row of them follows the 
front boundary of the large muscle of the 
neck. These are known as the anterior cervi- 
cal glands. Another row, which follows the 
posterior boundary of the large muscle of the 
neck, are known as the posterior cervical 
glands, while directly beneath the jaw there 
are numerous glands which are known as the 
submaxillary or sublingual glands. Ordina- 
rily, these glands cannot be felt. When any 



148 HEALTHY CHILDREN 

infection occurs, particularly through the 
mouth, the glands in the neck are apt to ab- 
sorb some of the infectious material and 
become inflamed and enlarged. 

Symptoms 

The glands increase in size so that they can 
be felt readily as small, hard nodules just 
beneath the skin. If they are simply in- 
flamed, they will be painful to the touch as 
well as swollen. This inflammation, however, 
may go on to the point where pus forms, in 
which case the skin over the gland becomes 
slightly discolored, and if left untreated the 
pus in the gland burrows through the skin, 
usually appearing on the outside of the neck. 
In some instances the pus burrows toward the 
inside and the opening may be in the child's 
throat. 

Cause 

Enlarged glands are usually due to the 
presence of some infection. They are com- 
monly associated with decayed teeth. What 
is known as an ulcerated tooth, or the forma- 
tion of a gum boil at the root of a tooth, 
frequently results in an enlarged and painful 
gland and occasionally in an infected gland 
which forms an abscess with pus and finally 
ruptures. In some infectious diseases the 



COMMON DISEASES OF CHILDHOOD 149 

glands enlarge, and they may occur in under- 
nourished or anemic children. Frequently, 
infection of a gland does not go beyond the 
point of making the gland swollen and tender, 
but occasionally they become acutely pain- 
ful, much swollen and tend to "break down," 
that is, the contents become cheesy masses of 
pus. 

Treatment 

When the cause of infected glands is bad 
teeth, the treatment is obvious. The teeth 
should be cared for properly, mouth hygiene 
should be practiced 'and necessary fillings and 
extractions should be made. Usually the 
glands will get entirely well as soon as the 
cause is removed. If the swollen glands are 
the result of an ulcerated tooth, treatment 
should be begun at once so that the pus from 
the tooth abscess will not burrow through and 
force an opening on the outside of the neck. 
When this happens, permanent scarring of 
the neck usually results. 

Enlarged tonsils should be removed as a 
precautionary measure in the prevention of 
infected glands. If the glands are already 
inflamed, however, it is wiser to wait until the 
inflammation has subsided before having the 
tonsils taken out. The nutrition of the child 
should receive attention. The early home 



150 HEALTHY CHILDREN 

treatment of inflamed glands is, first, to paint 
them with tincture of iodine. This may be 
repeated every two or three days, but should 
be stopped for a week or two if the skin be- 
comes sore. The glands should not be rubbed 
or irritated in any way. If the inflammation is 
at all acute, application of an ice bag or cold 
compresses is advised. If the skin over the 
glands becomes red and much swollen, and if 
tenderness is present, it is probable that the 
glands will have to be opened. This should 
be done only by a physician. In order to 
determine the exact cause of enlarged glands 
and to secure proper treatment, the advice 
of a physician should be sought at the earliest 
possible opportunity. 

TONSILLITIS 

This is a general constitutional disturbance, 
with high fever, rapid pulse and a moderate 
amount of prostration. It may or may not 
be accompanied with pain in the back or 
limbs. The local symptoms are manifested 
by sore throat. Examination shows the ton- 
sils reddened and inflamed, with small white 
patches appearing over their surface. 

Treatment 

Because tonsillitis may so closely resemble 
diphtheria, there should be no delay in ob- 



COMMON DISEASES OF CHILDHOOD 151 

taining medical advice when any child is 
ill with a sore throat. Before the doctor 
comes, however, it is advisable to give the 
child a dose of castor oil or calomel in doses 
of one-tenth of a grain every fifteen minutes 
for ten doses or until one grain in all has been 
taken. This should be followed by a saline 
cathartic. If the child is old enough to 
gargle, it may do so with a solution of one 
teaspoonful of salt to a glassful of hot water. 
Cold compresses or an icebag on the head 
often affords some relief. Medical treatment 
and local treatment of the throat can be pre- 
scribed only by a physician. 

EARACHE 

Earache is not at all uncommon during 
childhood. It is exceedingly difficult to diag- 
nose, except in older children, as younger 
ones are rarely able to tell the location of the 
pain. 

Cause 

It is caused generally by repeated coughs or 
colds or the presence of adenoids. It com- 
monly follows some of the infectious diseases, 
particularly scarlet fever. In such instances, 
we have an acute infection of the ear. Ear- 
ache at any time may be an indication of more 
serious ear trouble, and therefore should re- 
ceive medical attention at once. 



152 HEALTHY CHILDREN 

Symptoms 

Very young children appear quite ill, but 
for no marked reason. Usually there is a good 
deal of drowsiness but the sleep is restless, 
the child tossing about from side to side and 
constantly moving its head. Older children 
may put their hands up to the affected ear, 
thus indicating the seat of the pain. Younger 
children, however, rarely do this. A child 
who is old enough to talk will usually say 
that its head hurts or its ear aches. The 
pulse invariably is increased in frequency and 
the temperature may rise as high as one hun- 
dred five degrees Fahrenheit. 

Treatment 

The first step in the treatment of earache 
is relief of the pain and quieting the child's 
discomfort. Hot compresses are best. These 
usually give more relief if they are dry. One 
of the following may be used: a hot water 
bag, care being taken to see that it is not hot 
enough to burn the child, or a square, rather 
flat bag filled with salt and placed in the oven 
until thoroughly heated. If nothing else 
is available, a saucer may be heated in the 
oven, covered with cloth and placed at the 
side of the child's head. The ear should be 
irrigated with hot boric acid solution every 



COMMON DISEASES OF CHILDHOOD 153 

three hours. Usually the pain may be con- 
trolled fairly well in this way, but, owing to 
the serious results that may follow earache, 
a physician should be summoned and his 
advice followed from the beginning of the 
illness. The trouble in the ear may subside 
entirely or it may increase to the point where 
the eardrum is punctured. If this occurs 
there is almost immediate relief and a distinct 
fall in temperature. There may be a dis- 
charge from the ear, which tends to become 
chronic. In such cases the ear should be irri- 
gated carefully with boric acid solution once 
each day so that it may be kept as clean as 
possible, 

HICCOUGHS 

Hiccoughs are a succession of spasms of the 
diaphragm and consist in more or less regular 
interruption to the rhythm of breathing, with 
a sharp, gulping sound occurring in place of 
the normal respiration. In young children 
hiccoughs may be persistent and alarming. 
Frequently the condition occurs without any 
appreciable cause and there may be repeated 
attacks. Sometimes the cause will be found 
to be a slight attack of indigestion. Not un- 
commonly it is a result of too rapid eating. 
Occasionally special articles of food, particu- 



154 HEALTHY CHILDREN 

larly those that are highly seasoned, very hot 
or very cold, will excite an attack. 

Treatment 

Treatment should be directed toward re- 
moval of the cause and prevention of the 
spasm. When the attack is caused by in- 
digestion, the child may be given a quarter- 
teaspoonful of soda bicarbonate (baking soda) 
in a quarter-glassful of water or a teaspoonful 
of rhubarb and soda mixture diluted with one- 
quarter glassful of water. If any article of 
food is known to disagree with a child and to 
produce hiccoughs, its use should be avoided. 

For the attack itself, effort should be di- 
rected toward holding the breath long enough 
to interrupt the spasm of the diaphragm. 
This may be done in older children by teach- 
ing them to inhale very slowly until the lungs 
are filled with air and then to hold the breath 
as long as they can, finally exhaling the air 
in an equally slow manner. Usually, one or 
two repetitions of this breathing exercise will 
stop the hiccoughs. The old idea of taking 
nine swallows of water without breathing has 
the same principle and is easily applicable to 
children who cannot be made to hold the 
breath in any other way. 



COMMON DISEASES OF CHILDHOOD 155 

HEADACHE 

Headache in young children may be a 
simple matter, due to some exciting cause, 
or it may be a symptom of a serious disease. 
If the headache does not respond to treat- 
ment within twelve hours, and if any other 
symptoms of illness, such as fever or increased 
pulse rate, arise during that time, it is probable 
that the headache is a symptom of more 
serious disease and the doctor should be 
summoned. 

Simple headache in children may be due to a 
variety of causes, of which indigestion and 
chronic constipation are probably the most 
common. Playing too hard and too con- 
tinuously, late hours with over-excitement, 
too frequent attendance at the movies, par- 
ticularly at night, over-confinement in badly 
ventilated rooms, eyestrain of any kind, over- 
exertion in hot weather, nervous instability, 
impacted or decayed teeth, adenoids and nasal 
catarrh, are common causes. 

Symptoms 

The child usually complains of pain in its 
head. This may be localized in some one 
spot or the whole head may ache. Occasion- 
ally there will be pain on turning the head 
from side to side. Usually there is a good 
deal of prostration, the child is unwilling to 



156 HEALTHY CHILDREN 

get up, does not want to play, objects to 
strong light and occasionally complains of 
nausea. There may or may not be vomiting. 
These symptoms vary in severity, ranging 
from simple pain in the head to complete 
prostration and what seems to be serious 
illness. 

Prevention 

Prevention of headache consists in removing 
the underlying cause. This may be lack of 
ventilation in the sleeping room, too little 
outdoor play or lack of exercise. In some 
cases over-excitement, late hours and too 
frequent attendance at the movies, with the 
close air and constant eyestrain, must be 
guarded against. Particular attention should 
be paid to the digestion and to the condition 
of the bowels and special effort made to avoid 
constipation. If there is any question of 
eyestrain, the eyes should be examined by a 
competent oculist. If the child is subject to 
headache, the routine of its life must be out- 
lined carefully. There should be sufficient 
sleep, plenty of outdoor play and a light, 
readily digestible diet. 

Treatment 

Treatment will depend upon the cause, and 
usually it is easy for the observant mother to 



COMMON DISEASES OF CHILDHOOD 157 

know why a child has a headache. The gen- 
eral treatment consists in complete rest in a 
cool, dark room. Cold cloths or icebags 
should be applied to the head and the child 
should be given a cathartic, preferably castor 
oil. In some cases a hot foot bath will afford 
relief, and if indigestion or constipation is the 
cause, colon irrigations are frequently bene- 
ficial. Drugs should not be given, except 
under the doctor's orders. The only excep- 
tions to this rule are soda bicarbonate or 
rhubarb and soda mixture, which will re- 
lieve the accompanying indigestion. The diet 
should be very light for at least twenty-four 
hours, consisting mainly of liquid foods. 

WORMS 

Intestinal worms found in children are of 
three kinds: tape worms, round worms and 
pin or thread worms. The latter is the only 
species found in babies. As the child grows 
older, pin worms are still the common type, 
although the round worm or tape worm may 
also occur. All these varieties develop in the 
intestines. It is not definitely known how 
they gain entrance into the body, but it is 
believed that the eggs from which they de- 
velop are found on food that has not been 
washed sufficiently or cooked before being 
eaten. 



158 HEALTHY CHILDREN 

The tape worm usually occurs singly. It 
may be very long, ranging from fifteen to 
twenty-five feet. Generally it is about one- 
quarter to one-third of an inch in width, and 
resembles a long piece of tape, cut into seg- 
ments or pieces from one-half to one inch long. 
These segments are joined together lightly. 
They pass off with the bowel movements 
separately or in small groups and are recog- 
nized easily by their white color, size and 
shape. 

Round worms are white and closely re- 
semble the common earth worm or angle 
worm in appearance. They may be from 
three to eight or even ten inches long. 

Thread worms appear as little shreds of 
white thread. They are from one-quarter 
to one-half inch in length and are difficult 
to distinguish except after careful observation. 
Sometimes, on examination of the child's 
rectum and the folds along the external 
genitals, the presence of these tiny worms will 
be shown. 

Symptoms 

There may be no symptoms except finding 
the worms or their eggs in the stools. The 
other symptoms which may occur are great 
irritability and nervousness, disturbed sleep 
or night terrors. Gritting of the teeth during 



COMMON DISEASES OF CHILDHOOD 159 

sleep is not uncommon. Constant picking 
at the nose, both when awake and asleep, is 
usually a sign of some intestinal irritation. 
There may be headache and loss of appetite. 
Diarrhoea and colic are not uncommon. The 
child will complain of itching of the rectum 
and usually there are symptoms of indigestion 
with accompanying bad odor of the breath. 
Any or all of these symptoms may occur in 
other conditions; therefore, the diagnosis can 
be made only by the finding of the worms or 
their eggs in the feces. 

Treatment 

Treatment of tape worm or round worm 
is a matter for a physician to decide and the 
use of special medicine cannot be advised. 
In the case of the tape worm, it is important 
to see that every part of it is removed, and 
in the case of the round worms that they are 
entirely eliminated. Both conditions are 
serious enough to warrant obtaining the best 
possible medical advice. 

Pin or thread worms may be treated at 
home. The best method is to give the child 
a good cathartic, preferably castor oil or calo- 
mel. Once a day the rectum should be irri- 
gated thoroughly with the following solution: 
one ounce of quassia chips boiled for ten 
minutes in a pint of water, sufficient water 



160 HEALTHY CHILDREN 

being added from time to time to keep the 
final amount at one pint. The solution 
should be strained and used while warm. 
Absolute cleanliness of the rectum and ex- 
ternal genitals is essential. 

The preventive treatment of intestinal 
worms is to see that the child's hands are 
washed thoroughly before each meal and that 
food is not eaten until it has been either 
cooked or made perfectly clean. 

HIVES (URTICARIA) 

Hives occur as an eruption which may be 
general all over the body or confined to some 
one part of it. The eruption consists of 
elevated white or pinkish spots surrounded by 
marked redness. It is apt to appear rather 
suddenly, and may persist for several days 
or disappear within a few hours. It does not 
leave any scars. 

Cause 

The cause is usually due to some form of 
indigestion. Many people have what is known 
as a marked idiosyncrasy to certain articles 
of food. Fish is apt to cause attacks of hives, 
particularly if it is not fresh. This is true 
particularly of shell-fish such as crabs, lobster 
and oysters. In some instances berries, espe- 
cially strawberries, cause hives, while it is not 



COMMON DISEASES OF CHILDHOOD 161 

uncommon in some children to see marked 
attacks of hives as a result of eating eggs. 
Certain drugs will produce this eruption. In 
some persons no particular articles of food can 
be discovered as the cause, and the attack 
may be the result of eating food that is not 
entirely fresh. 

Symptoms 

The most prominent symptoms are dis- 
comfort of the skin caused by the inflam- 
mation of the eruption and the intense itching 
that accompanies it. This itching may be 
so severe as to lead to loss of appetite, dis- 
turbance of sleep and general irritability and 
restlessness, particularly in young children. 

Treatment 

An active cathartic should be given at once, 
preferably a dose of epsom salts or castor oil. 
The diet should be extremely light and con- 
fined to liquids for several hours or a day. 
Soda bicarbonate in from one-quarter to one- 
half teaspoonful doses, depending upon 
the age of the child, or rhubarb and soda 
mixture in appropriate doses, will be 
found helpful. To relieve the itching, bran 
or soda baths may be given two or three 
times a day, with the water at a temperature 
not above eighty-five degrees. The skin 



162 HEALTHY CHILDREN 

should be patted dry, not rubbed, after the 
bath, then covered with some dusting powder. 
Ordinary talcum powder is excellent for this 
purpose, but in the case of intense itching, 
stearate of zinc powder will often be found to 
give the greatest relief. 



CHAPTER VIII 

INFECTIOUS AND CONTAGIOUS 
DISEASES 

There are always two factors to be con- 
sidered in the occurrence of any infectious 
disease: first, the presence of the bacteria or 
germs that cause the disease; and, second, 
the resistance of the individual. A certain 
number of children are naturally immune to 
various infectious diseases; others are ex- 
tremely susceptible. In general, very young 
babies are apt to be immune to these diseases. 
This immunity begins to lessen at about the 
sixth month, and the child becomes more and 
more susceptible up to two or three years of 
age. After that time, some children begin 
to acquire natural immunity to some types 
of disease, and this immunity increases until, 
in adult life, the great majority of people are 
immune to the ordinary infectious diseases. 
For these reasons, it is natural to expect the 
greater proportion of the infectious diseases 
to occur in early child life, and this is borne 
out by the statistics that have been gathered 
in regard to the matter. It is probable that 
eighty per cent of all cases of the common 
infectious diseases occur in children under five 
years of age. The greatest danger in con- 
nection with these diseases does not come in 



163 



164 HEALTHY CHILDREN 

the ordinary course of the disease itself, but 
rather as a result of the complications that 
may occur. While good health in a child 
will not prevent infectious disease, it gener- 
ally causes the attack to be light, and in some 
of the infectious diseases, notably tuber- 
cuosis, good health seems to be the one thing 
that will actually prevent development of the 
disease. 

Knowledge of how infectious diseases are 
transmitted has been distinctly advanced 
during the past few years. Formerly it was 
believed that most of these germs were car- 
ried through the air so that it was possible 
to contract infectious diseases merely by 
association with a person already infected. 
Now we know that there are few of these 
diseases in which the germs are air-borne, 
and that the only way in which most of them 
can be contracted is by intimate personal 
association with the sick person. Such dis- 
eases can be carried from one individual to 
another, if the discharges from the nose, 
throat or bowels of the patient are carried 
on the hands or clothing. The main way by 
which infectious diseases are transmitted is 
through the spray that comes from the mouth 
or nose of the infected person while coughing 
or sneezing. Normally, the infectious ma- 



INFECTIOUS AND CONTAGIOUS DISEASES 165 

terial is not carried through the air beyond 
a distance of three or four feet. 

Infectious diseases may be carried from one 
person to another by people who are known as 
"carriers." These are individuals who are 
not themselves ill but who are capable of 
harboring the germs of a given disease and 
by means of coughing or sneezing, or through 
the bowel discharges, transmitting the germs 
to a third person. Diphtheria germs may be 
carried in the throat of a perfectly well per- 
son, while there are many instances on record 
where typhoid fever germs have been found 
in the bowel discharges of people who were 
in apparent good health. 

There is a superstition which still persists 
in some parts of the country that everyone 
must have all the commoner infectious dis- 
eases some time during their lives, and that it 
is better to expose children to measles, 
chickenpox, scarlet fever and mumps in the 
hope that the attacks will be light, rather than 
to risk similar exposure in later life. Every 
mother should understand that a child should 
never be exposed needlessly to an infectious 
disease. These diseases, while often looked 
upon as necessary accompaniments of child- 
hood, are quite avoidable in a large pro- 
portion of cases. 



166 HEALTHY CHILDREN 

In order to prevent infectious diseases and 
to avoid epidemics in a community, it is neces- 
sary to have proper health laws that are en- 
forced. The sanitary and hygienic conditions 
in any town should be maintained at the 
highest standard. All persons who are ill 
with an infectious disease should be quaran- 
tined by the local health authorities until all 
danger of transmitting the infection has 
passed. The possibility of transmitting in- 
fectious diseases by means of water, milk or 
foodstuffs should lead fathers and mothers 
to demand that the health authorities of their 
towns provide a clean and pure water supply, 
pasteurization of all milk that is not known 
to be absolutely pure, and the sanitary and 
hygienic handling of all foodstuffs. Green 
vegetables, because of the possibility of their 
being handled by persons who are infected, 
may be a means of transmitting disease. 
This is because these vegetables, in so many 
instances, are eaten without having been 
washed. Street dust may harbor these germs 
and thereby infect vegetables, fruits or other 
articles that have been exposed. The only 
safe way is to see that such fruits and vege- 
tables are washed thoroughly before they are 
eaten. 

Proper health laws in a community are 
absolutely essential for the prevention of 



INFECTIOUS AND CONTAGIOUS DISEASES 167 

epidemics and separate cases of infectious 
disease. It is necessary also to carry out 
certain rules with regard to the hygiene of 
children for the purpose of avoiding, as far as 
possible, contraction of any of these diseases, 
and in order to keep the child in as good health 
as possible so that, if the disease is contracted, 
the attack will be light and complications may 
be avoided. 

Measures of prevention include everything 
that tends to maintain good health and 
strength and to build up a strong, robust 
constitution in the child. Such measures of 
personal hygiene should be commenced in 
infancy and continued throughout childhood. 
The most important preventive aid is fresh 
air. It is well known that infectious diseases 
reach their height in the winter months, 
usually during February and March, and then 
tend to grow less frequent. During the sum- 
mer months they are practically unknown. 
In all probability this is not because the germs 
are more prevalent during the winter or be- 
cause they develop better in the cold weather. 
It is probably on account of the common 
practice of keeping windows closed during the 
winter and opening them in the summer. 
Fresh air and sunlight are the greatest de- 
stroyers of all germ life, and if they were as 
readily available during the cold weather as 



168 HEALTHY CHILDREN 

they are in the summer, it is probable that 
infectious diseases would be no more common 
in February than they are in July. This is 
one of the reasons why children should have 
the advantage of fresh air as much as possible 
during the daytime throughout the year, and 
their play should always be in well ventilated 
rooms, when it is necessary to keep them 
indoors. Sleeping rooms should have an 
abundance of fresh air throughout the night. 

Overclothing is also a matter to be guarded 
against. Clothing for indoors should be little, 
if any, heavier during the winter than during 
the summer months, and in order to prevent 
chilling of the body, care should be taken to 
see that the outer clothing is sufficient for 
warmth. Attention should always be paid 
to wet feet, particularly during the winter 
months, and children should never be allowed 
to wear wet shoes and stockings. 

A cool sponge bath daily with a warm tub 
bath at least twice a week promotes elimi- 
nation of waste material from the body and 
thus has a great tendency to keep the child 
in sound health. Good, wholesome food and 
plenty of recreation are necessary. Special 
attention should be paid to the care of the 
mouth and teeth. The main point of entrance 
for all bacteria to the body is through the 
mouth. Decayed teeth are a breeding place 



INFECTIOUS AND CONTAGIOUS DISEASES 169 

for germs. Attention to decayed teeth and 
cleanliness of the mouth are of the utmost 
importance in preventing individual infection. 
The presence of adenoids and enlarged tonsils 
also predisposes to infectious disease. 

During the early years of life the mother 
must control the health habits of her child. 
By the time it is two or three years old, there 
is no reason why it should not learn the kind 
of health habits that will tend toward pre- 
vention of infectious and other diseases, and 
the following rules should be observed: 

1st: The teeth should be brushed after each meal and on arising 
in the morning. 

2nd: The hands should be washed before each meal and after 
going to the toilet. The fingernails should be kept ab- 
solutely clean. 

3rd: No toy, pencil or other article that has been used by 
another child should ever be put into the mouth. Disease 
germs are easily carried in that way. 

4th: Each child should have a fresh pocket handkerchief every 
day. He should not lend it to anyone and should not 
borrow one from any other child. This handkerchief 
should be held over the mouth when coughing or sneezing. 

5th: A child with a cough or cold should be kept entirely apart 
from other children and should not be allowed to come into 
contact with them in any way until it has been determined 
whether or not some infectious disease is about to develop. 

6th: Each child should have its own drinking cup and towel, 
both at school and at home, and these should not be used 
by anyone else. 

7th: A child should not be kissed on the mouth by anyone but 
its mother, and she should not do this unless she has every 
reason to know that she is in good health. 



170 HEALTHY CHILDREN 

Early Symptoms of Infectious Diseases 

Every mother should know the early signs 
of the various infectious diseases, the main 
symptoms and the length of time the child 
should be kept isolated. Frequently children 
have these diseases in so mild a form that a 
physician is not sent for. Sometimes cases 
that seem mild in the beginning later become 
serious, so that in every instance a doctor 
should be summoned at once if a child is ill. 

All the common infectious diseases have 
certain marked characteristics but there are 
some cases where children simply develop 
high temperature and where it is impossible 
to decide whether or not the illness is of an 
infectious nature. Young children are par- 
ticularly susceptible to sudden rises in temper- 
ature. This may be due merely to some 
digestive disturbance, but because of the pos- 
sibility of the disease being infectious every 
child who is taken ill should be isolated at 
once and kept apart from others until the 
nature of the disease has been determined. 

At the onset of any illness, it is wise to give 
a good cathartic, preferably a tablespoonful 
of castor oil or calomel in one-tenth grain 
doses every fifteen minutes until ten doses 
(one grain) have been taken. If calomel is 
used, it should be followed in four hours with 



INFECTIOUS AND CONTAGIOUS DISEASES 171 

a saline cathartic such as citrate of magnesia or 
epsom salts. If the calomel is given at night, 
the saline cathartic may be given next morning. 

Children who have fever should be put on a 
liquid diet at once and no solid food should be 
given for at least twenty-four hours. Milk is 
the best food to use and thin cereal gruels and 
milk soups may be given in addition. The 
child should drink plenty of water. It is best 
to do this in a routine way, and a glass of 
water may be offered to the child every two 
hours and it should be urged to drink as much 
as possible. A cool sponge bath will often 
reduce the temperature and make the patient 
more comfortable. Most important of all, 
isolation must be insisted upon at the begin- 
ning of an illness. This means keeping the 
child away from everyone else in the house- 
hold except the mother or the nurse. 

Because of the nature of infectious diseases 
and the fact that at any time complications 
may occur which may prove dangerous, medical 
attention should be obtained at the earliest pos- 
sible moment. Except in the case of diphtheria 
and whooping cough, there is no specific treat- 
ment that can be directed toward the cure 
of any of these diseases, and the medical 
treatment should be left entirely to the phy- 
sician. However, the mother should be in- 
telligent regarding the nature of the disease 



172 HEALTHY CHILDREN 

and should have a general knowledge of the 
home care that is necessary. 

MEASLES 

This is the most common of the infectious 
diseases of childhood. Few persons live to 
adult life without having had it. In itself, 
measles is not a dangerous disease. The main 
difficulty lies in the complications; that is, 
in serious bronchitis or pneumonia, which 
sometimes occur. 

Symptoms 

The onset or first symptoms are those of cold 
in the head. There mayJDe slight fever, inflamed 
eyes with a good deal of watery secretion, 
running of the nose, sneezing and coughing. 
Frequently, the child will complain of the light 
and will want to remain in a dark room. The 
rash, consisting of small, irregular groups of 
dull red, slightly raised spots, does not appear 
until the third day after the first symptoms 
begin, and usually it is first seen on the fore- 
head and face, and then spreads rapidly over 
the entire body. 

Method of Infection 

Measles is carried through the discharges 
sprayed or thrown from the nose or mouth 
in coughing, sneezing or spitting. There is 



INFECTIOUS AND CONTAGIOUS DISEASES 173 

therefore no reason why it should be trans- 
mitted if other children are not allowed in 
the sick room and if all body discharges are 
carefully burned or otherwise destroyed. 

Home Care 

A child who is sick with measles should be 
kept in a cool, comfortable and well-darkened 
room until the rash has disappeared and it 
no longer dreads the light. Warmth and good 
nursing are essential. Often light diet and 
care are all that are needed to bring a case 
through without complications. The child 
must be kept isolated until all signs of the rash 
have disappeared and there is no longer any 
discharge from the nose and throat. 

GERMAN MEASLES 

This resembles measles somewhat but is 
much lighter in form. 

Symptoms 

Frequently the child does not complain of 
feeling sick at all. The initial symptom is the 
rash, which occurs first on the face and then 
spreads rapidly over the body. The rash may 
resemble that of measles or scarlet fever. 
Enlargement of the glands back of the ear is 
the characteristic symptom to be noted. 
These appear as rounded, irregular protuber- 



174 HEALTHY CHILDREN 

ances and are somewhat tender. The eyes 
may be slightly inflamed and a low degree of 
fever may occur for a day or two. 

Method of Infection 

This very infectious disease is spread in the 
same way as measles. 

Home Care 

The disease needs little treatment other 
than good nursing and light diet to effect a 
cure. 

SCARLET FEVER 

This is a serious disease, and although not 
nearly as infectious as measles, it is one that 
is rightly dreaded. 

Symptoms 

This disease usually manifests itself sud- 
denly. The child may vomit or complain of 
sore throat. Sometimes fever or a sharp 
headache is the first symptom noted. The 
rash, consisting of fine spots which are so 
close together that it seems as though the 
entire skin were a bright red, appears within 
twenty-four hours after the child begins to 
feel sick. First it breaks out on the neck and 
upper part of the chest. The rash will last 
from three to ten days and will then fade 



INFECTIOUS AND CONTAGIOUS DISEASES 175 

gradually. Later, at a period varying from 
two to three weeks, the skin of the body is apt 
to scale off, sometimes in fine pieces and 
sometimes in strips of considerable size. 

Method of Infection 

Scarlet fever is transmitted by the dis- 
charges thrown or sprayed from the mouth 
or nose in coughing, sneezing or spitting, and 
by discharges from other parts of the body. 
Because of its serious nature, unusual care 
must be taken with all body discharges. Burn 
them immediately or otherwise destroy them. 
The mother or nurse who cares for the child 
must be particularly careful in handling these 
discharges. She should wash her hands fre- 
quently jand always before touching food. 
The clothing she wears in the sickroom should 
always be changed and other clothing put 
on before she comes into contact with other 
people. 

Home Care 

Early and careful attention is of the first 
importance in this disease. Good nursing, 
light diet, plenty of water, extreme cleanli- 
ness, with rest and quiet, are necessary. 
There is always the possibility of serious com- 
plications following scarlet fever. For this 
reason it should never be viewed lightly and 



176 HEALTHY CHILDREN 

a child with this disease should always have 
medical care. 

CHICKENPOX 

Symptoms 

Very often there are no early symptoms of 
this disease, and the first thing noticed is the 
rash. Occasionally there may be slight fever. 
The rash, consisting of small, raised pimples 
which later become filled with fluid, appears 
usually on the second day. Within a few 
days scabs form over the top of these raised 
spots. There may be successive crops of this 
eruption for a period of as long as ten days. 

Method of Infection 

Because the disease can be transmitted only 
through the secretions contained in the erup- 
tion, an infected child should be isolated and 
kept absolutely away from other children 
until all scabs have fallen off and the spots 
are completely healed. 

Home Care 

Chickenpox needs no unusual care. Isola- 
tion and the ordinary principles of nursing 
must be carried out. Unless otherwise direct- 
ed by the physician, the child need not be 
kept in bed during the illness, but may play 
about in a warm, well ventilated room. 



INFECTIO US A ND CO NT A GIO US DISEA SES 1 7 7 
MUMPS 

Symptoms 

So characteristic is this common disease of 
childhood that it is rarely mistaken for any 
other. Its beginning may be sudden or 
gradual. The child will complain of not feel- 
ing well and of pain at the angle of the jaw. 
The mouth may be dry, and the saliva sticky 
and scant. There may be difficulty in open- 
ing the mouth because of the stiffness of the 
jaws, and, in many instances, actual pain is 
felt at the sight of sour foods such as pickles. 
The characteristic symptom, which is apt to be 
very painful and may last several days, is 
swelling in front of the ear. 

Method of Infection 

The infectious material of mumps is carried 
by means of the discharges from the nose and 
throat and the period during which the in- 
fection may be transmitted lasts as long as 
there is any swelling. 

Home Care 

Mumps in itself calls for no particular 
treatment except nursing. However, if the 
swelling is unsually severe, or if the child com- 
plains of much pain, medical advice should be 
sought and followed. 



178 HEALTHY CHILDREN 

WHOOPING COUGH 

Symptoms 

The early symptoms of whooping cough are 
usually those of ordinary cold in the head. 
Later there is a persistent cough. The char- 
acteristic "whoop" does not appear until 
about a week after the onset of the disease. 
Sometimes early in the disease, and almost 
always later on, the main symptom that is 
noted consists of spasms of coughing. During 
these spasms the child appears to be choked, 
usually takes hold of an article of furniture 
or buries its head in its mother's lap. These 
spasms may be quite violent at times, and 
often end in attacks of vomiting. 

Method of Infection 

Formerly it was thought that the disease 
was infectious during the entire "whooping" 
period, but now it is believed that its most 
infectious period does not last longer than two 
weeks after the first appearance of the 
"whoop." Because of the possibility of the 
infection being transmitted for a greater 
length of time, it is still considered necessary 
to keep these children away from others dur- 
ing the entire time that they are whooping. 
The disease is spread by discharges sprayed 



INFECTIOUS AND CONTAGIOUS DISEASES 179 

or thrown from the nose or mouth in coughing, 
sneezing or spitting. 

Home Care 

The home care of whooping cough is diffi- 
cult because the child should be kept out- 
doors as much as possible. Fresh air is 
one of the greatest helps we have in the treat- 
ment of this disease, but at the same time the 
infected child should be kept away from other 
children. Children with whooping cough 
should never be taken in public conveyances. 
While the disease is usually considered a light 
one, it must be remembered that it is apt to 
be very dangerous when it occurs in young 
babies. For this reason, whooping cough 
should never be neglected but should receive 
as careful attention as a case of scarlet fever. 

DIPHTHERIA 

Symptoms 

The early symptoms are those of sore 
throat, with a rise in temperature. The ton- 
sils are the most common location of the local 
symptoms. They may be red and swollen 
and covered with a grayish patch. Diph- 
theria may occur with the symptoms manifest 
in the nose or larynx. Any pustular or 
bloody discharge from the nose or any sore 
throat is an indication that medical advice 



180 HEALTHY CHILDREN 

is necessary. Diphtheria is such a serious 
disease, if left untreated, that proper medical 
care must be obtained at the earliest possible 
moment. 

Method of Infection 

The disease is conveyed by discharges 
sprayed or thrown from the nose or mouth 
in coughing, sneezing or spitting and the aver- 
age duration of the infectious period is about 
twelve days. A person who has had diph- 
theria cannot be considered well or ready to 
be discharged from quarantine until the doc- 
tor has made the necessary examinations and 
determined that the nose and throat are free 
from diphtheria bacilli. 

Prevention and Treatment 

This, the most dreaded disease of child- 
hood, is the only one of the infectious diseases 
in which we have positive knowledge of 
methods of prevention and cure. Every 
child who has a sore throat should receive 
medical attention so that it may be deter- 
mined as early as possible whether or not the 
disease is diphtheria. Diphtheria antitoxin 
should be administered only by a physician. 
When it is given to children who are likely 
to be or who have been exposed to the disease 
it renders them immune for a period of about 



INFECTIOUS AND CONTAGIOUS DISEASES 181 

three weeks. During that time there is 
practically no danger of their becoming in- 
fected. If the child has already contracted 
the disease, there should be no delay in giving 
the diphtheria antitoxin at as early a moment 
as possible. If given thus early and in suffi- 
cient amounts, it is an almost certain cure of 
the disease. If it is used later, it frequently 
shortens the attack but it is not always suc- 
cessful. For this reason, immediate use of 
diphtheria antitoxin in every case of diph- 
theria or exposure to diphtheria is strongly 
urged. 

In recent years great advances have been 
made in our knowledge of diphtheria. Schick, 
an Austrian physician, in 1913 discovered a 
test whereby it is possible to tell persons who 
are naturally immune to diphtheria and those 
who are not. The Schick test can be given 
only by a physician. It consists in the in- 
jection in the skin, usually just below the 
fold of the elbow, of a small quantity of 
diphtheria toxin. If the child is not immune, 
there can usually be seen, in about three days, 
a certain area of pigmentation or discolor- 
ation at the site of the injection. If the child 
is immune, there is rarely any discoloration 
at this point. If it is shown that the child is 
immune, it means that it will not contract 
diphtheria. If it is not immune it means 



182 HEALTHY CHILDREN 

that it is susceptible to diphtheria and may 
contract it at that time, although later it 
may become immune. 

If a child is found not to be immune to 
this disease, it is now possible for a physician 
to give an injection of what is known as 
" toxin antitoxin vaccine.' ' This does not 
render the child immediately immune to 
diphtheria but, after a period of a few weeks, 
immunity begins to develop and it is believed 
that thereafter the person having such in- 
jection cannot contract diphtheria. The in- 
jection of toxin antitoxin for the prevention 
of diphtheria is as simple as vaccination 
against smallpox, and it is hoped that its use 
will become as universal. 

TUBERCULOSIS 

Tuberculosis is not an inherited disease; 
that is, it does not descend from the father or 
mother to the child. Children born of par- 
ents who have tuberculosis are nearly always 
delicate in physique and have what is known 
as an "inherited tendency' ' which makes 
them much more likely to contract the disease 
than children born of healthy parents. Also, 
the association of such children with fathers 
or mothers who have tuberculosis makes it- 
much more probable that they will become 
infected. However, as long as we know that 




■ 






T™ 



Undernourished Child 



INFECTIOUS AND CONTAGIOUS DISEASES 183 

children do not directly inherit tuberculosis, 
it is possible to do a great deal in the way of 
prevention by giving them unusual care in 
regard to their health and by seeing that, as 
far as possible, they are kept away from any 
chance of infection. 

Such delicate children, in fact all children 
who are undernourished, should live almost 
entirely outdoors. Sleeping outdoors should 
be begun at an early age unless the weather 
is very cold and stormy. If a sleeping porch 
cannot be arranged, every effort should be 
made to have one room in the house as nearly 
open as possible and used as a bedroom for the 
susceptible or undernourished child. There 
should be no possibility of the child becoming 
chilled, and as much bed clothing as may be 
necessary should be used. Sleeping suits 
made like nightdrawers or pajamas, with feet 
attached, are the most comfortable as well 
as the safest garments to be used, and a sleep- 
ing cap is advised. If the body is kept warm, 
it does not make any difference how cold the 
air is, so unless the weather is stormy or un- 
usually cold, children who are undernourished 
or who are suspected of being susceptible to 
tuberculosis should always sleep outdoors. 

In general, these children should live out- 
doors most of the daytime, and should have 
practically no indoor life. Children of this 



184 HEALTHY CHILDREN 

type need extra food. Three nourishing meals 
a day and an additional lunch in the middle 
of the forenoon and in the middle of the after- 
noon are necessary. This extra lunch may 
consist of a cup of cocoa or a glass of milk 
with crackers or bread and butter. In cases 
of marked undernourishment, or where the 
child does not digest its food well, it is ad- 
visable to give a cup of hot cocoa before going 
to bed. Every effort should be made to see 
that the child's nutrition is kept up to normal 
and the methods outlined in the chapter on 
"Malnutrition" should be followed. 

CONTAGIOUS EYE DISEASES 
SIMPLE CONJUNCTIVITIS 

This is sometimes called "acute conjunc- 
tivitis" or simply "inflamed eyes." 

Cause 

The cause is usually irritation caused by 
dust blowing into the eyes or direct infection 
from the use of a pocket handkerchief that 
has been used by someone else who has in- 
flamed eyes. 

Symptoms 

The child complains that the eyes itch and 
the tendency is to rub them constantly. 
There is a watery discharge and a feeling as 
though there were some foreign particles in 




Method of Applying Tourniquet to Upper Arm to stop flow 

of Blood from Wound in lower part of Arm. See page 

198 for Instructions. 



INFECTIOUS AND CONTAGIOUS DISEASES 185 

the eye. There may be slight pain, but this 
is not common. The disease is easy to 
recognize. The white of the eye and the 
inner surface of the lids are red. The dis- 
charge is usually watery like the flow of tears 
but sometimes the lids are stuck together in 
the mornings by a gummy exudate which may 
be seen surrounding the eyelashes. 

Treatment 

The treatment consists in preventing the 
spread of the disease by seeing that the child 
uses only its own pocket handkerchief and 
towel and that while the condition lasts there 
is no close association between the affected 
child and others and that the same toys are 
not used by both. For the inflammation the 
best form of treatment is to flush out the eyes 
thoroughly with a boric acid solution. The 
method of doing this has been described under 
the section on "Prevention of Eyestrain" 
in the chapter on " Personal Hygiene/' 

PINK EYE OR ACUTE MUCO-PURULENT 
CONJUNCTIVITIS 

This is a serious disease of the eye which is 
caused by a particular form of bacteria which 
is known as the Koch-Weeks bacillus. 



186 HEALTHY CHILDREN 

Symptoms 

The child complains of great smarting and 
pain in the eyes, sensitiveness to light and 
keeps the eyes closed or blinks constantly. 
There is a sensation as if there were sand in 
the eyes. The white of the eye and inner sur- 
face of the lids are very red and inflamed and 
there is a discharge of pus mixed with mucus. 

Treatment 

This disease is extremely infectious and will 
spread rapidly throughout a family or among 
children if they are in close contact with an 
infected child. Children suffering from this 
disease should be kept entirely separate from 
other children. If medical treatment is avail- 
able, the child should be placed under the care 
of a physician at once. If not, it may be 
treated at home by flushing out the eyes with 
boric acid solution every two hours. The 
disease usually lasts for from ten days to 
two weeks. 

CONTAGIOUS SKIN DISEASES 
RINGWORM 

This is a contagious disease which occurs 
generally on the face, hands or arms, but rarely 
on the body. It is probable that children can 
be infected by playing with cats or dogs who 
have the disease. 



INFECTIOUS AND CONTAGIOUS DISEASES 187 

Symptoms 

Ringworm occurs as a small, round, raised, 
reddish patch, usually on the face or hands. 
These patches are generally round, although 
they may be slightly irregular in shape. They 
tend to grow quite rapidly and as they grow 
the center of the patch heals, leaving a well 
marked, reddish ring which is characteristic 
of ringworm and gives it its name. There is 
rarely any itching and the child does not com- 
plain of the sore. Frequently there is only 
one ringworm. There may be several, how- 
ever, all growing at the same time but on 
different parts of the face, hands or arms, 
or there may be three or four in close connec- 
tion with each other, and these may join to 
form one large patch. 

Treatment 

Home treatment is common for this type 
of case as it is not serious, although apt to 
persist and to spread if not treated. It must 
be remembered that the disease is very con- 
tagious and children so affected should be 
kept away from other children unless some 
protective dressing is applied to the ringworm. 
The simplest and best form of such dressing 
is to paint the ringworm with tincture of 
iodine, giving it one coating so that the skin 



188 HEALTHY CHILDREN 

appears a light brown. This should be al- 
lowed to dry and the ringworm then covered 
with flexible collodion. This treatment may 
be repeated every other day until the sore is 
entirely healed. With this protective dress- 
ing the child may go about as usual, with no 
fear of transmitting the contagion to others. 

SCABIES 

This highly contagious disease of the skin 
is sometimes known as the "itch." It occurs 
more commonly among children who are not 
well nourished and who do not live in sanitary 
surroundings. It is transmitted by towels, 
clothing, pocket handkerchiefs or prolonged 
and close personal contact. It is not as in- 
fectious as ringworm but is a far more difficult 
disease to control and spreads much more 
rapidly when once contracted. 

Symptoms 

The first thing usually noticed is a slight 
eruption which appears between the fingers. 
If examined carefully when it first occurs, 
small white specks may be seen, and running 
from them will be slightly raised white or 
grayish lines from one-eighth to one-quarter 
inch in length. These specks mark the points 
where the tiny parasite which causes the 
disease has burrowed under the skin. The 



INFECTIOUS AND CONTAGIOUS DISEASES 189 

first symptom noticed by the child is one of 
intense itching, and as a result the infected 
place is scratched almost from the beginning, 
so that within a very short time all that can 
be seen are many pimples or pustules sur- 
rounded by red areas, with sometimes a good 
deal of inflammation and occasionally bleed- 
ing as a result of the scratching. The skin 
between the fingers is first affected, then the 
back of the hands and the back and front of 
the wrists. Later, the disease may spread 
to the forearms and if untreated the eruption 
may appear all over the body. The main 
characteristics are the starting point of the 
eruption between the fingers, the intense 
itching and the gradual extension of the in- 
fection. 

Treatment 

The home treatment of scabies consists in 
scrubbing the eruption with a stiff bristle brush, 
tincture of green soap and hot water. The 
affected parts should then be dried carefully 
and covered with sulphur ointment. When 
the eruption is on the hands, the child should 
wear white cotton gloves and not touch any 
article that is to be used by any other person. 
The treatment is to be repeated every other 
day. In the meantime, the part should be 
kept covered carefully with the ointment. 



190 HEALTHY CHILDREN 

Usually the disease will heal within a very 
few days as a result of this treatment. 

IMPETIGO 

This is a common skin disease which is 
generally found in children who are under- 
nourished and who do not live in good sanitary 
surroundings. It is very contagious and often 
the child will start with one sore appearing 
on the face, and, by scratching this sore and 
then scratching other parts of the body, there 
may be successive crops of these sores grow- 
ing in several places. Usually it is found on 
the face and hands. It is infectious and may 
readily be transmitted from one child to 
another by means of pocket handkerchiefs, 
towels, clothing, or any article that has been 
handled by the infected child. 

Symptoms 

A reddish patch will form on the face or 
hand of the child. This rapidly becomes in- 
flamed and secretes a yellow fluid which dries 
and forms a crust or scab. The scabs are 
irregular in shape, with turned-up edges. 
Around the edge there is a good deal of in- 
flammation or redness of the skin. There is 
rarely any itching but the sore itself is dis- 
figuring and may be quite large. 



INFECTIOUS AND CONTAGIOUS DISEASES 191 

Treatment 

The sores should be soaked thoroughly with 
tincture of green soap and warm water, and 
the crust or scab removed gently. Zinc oxide 
ointment should then be applied freely and a 
thick coating left on. The sores should be kept 
continually covered with the ointment but 
need not be covered with any other dressing. 

PEDICULOSIS 

Head lice are common among the children 
of our large cities. Because their occurrence 
is so widespread, anyone is apt to become 
infected, and even a well cared for child or 
adult may acquire these head lice or pedic- 
uli. The disease is classified as contagious 
because it is so readily transmitted from one 
person to another. It is not probable that 
pediculi live long unless they are on the 
human body, but it has been demonstrated 
that they can be transferred readily from one 
person to another by means of hats or other 
articles of clothing which have been infected. 

There are two common varieties of lice — 
those which infect the head and those which 
infect the body. They are quite different and 
body lice are not found on the head, nor head 
lice on the body. Body lice or what are now 
known as "cooties" are comparatively rare in 



192 HEALTHY CHILDREN 

this country, and the variety which commonly 
infests the hair of children and adults are 
those which live and grow on the hair or 
scalp. 

Symptoms 

Usually the first symptom noted is that the 
child is continually scratching the head. 
Closer observation may show that there is a 
certain amount of redness or even a slight 
eruption on the back of the neck, sometimes 
reaching for a considerable distance down 
the back. The only positive assurance that 
the condition exists is finding the actual bugs 
or pediculi in the hair. These pediculi breed 
very rapidly. First they deposit their eggs 
in the form of whitish particles which are 
closely adherent to the hair. These eggs or 
nits hatch out at the end of six or seven days, 
and in about two weeks the new pediculi are 
capable of breeding more. The nits or eggs 
are fastened to the hair by a gummy sub- 
stance and it is not possible to detach them 
unless this gummy substance is dissolved. 
The ordinary location of the eggs or nits is at 
the back of the head, behind the ears and just 
above the neck. They may usually be seen 
quite readily when the child's hair is lifted 
up, and appear as small white particles which 
closely resemble dandruff. 



INFECTIOUS AND CONTAGIOUS DISEASES 193 

Treatment 

The first object of the treatment is to get 
rid of the live pediculi, and second, to see that 
the nits are entirely removed from the hair 
and destroyed. As long as any nits remain 
there is always the possibility of reinfection. 
There are on the market a large number of 
solutions or cures for this condition. Tinc- 
ture of larkspur is an excellent remedy, but 
it is expensive. As it is a poison, it must be 
handled with great care, and never left within 
the reach of any child who may take it in- 
ternally. Also, it is not safe to use it on the 
scalp if there are any raw surfaces. If the 
disease is in an early stage and its use can be 
controlled, tincture of larkspur is a pleasant 
solution to use and may be applied in the same 
way as kerosene and sweet oil, which is the 
ordinary home treatment. 

In treating pediculosis, the hair should be 
soaked thoroughly with the tincture of lark- 
spur or with a mixture of equal parts of kero- 
sene and sweet oil. This must be rubbed 
thoroughly into the scalp, care being taken to 
see that every particle of the hair is wet. 
The hair should then be bound up loosely 
on the head and the whole covered with a 
towel which must be fastened in place and 
left overnight. In the morning, the hair and 



194 HEALTHY CHILDREN 

scalp should be washed thoroughly with hot 
soapsuds. After drying, a fine tooth comb 
should be used to see that all pediculi are 
combed out of the hair and, in addition, that 
as many as possible of the nits are removed. 
Usually the latter will be found to be a 
difficult process and it is probable that fur- 
ther efforts will have to be made to loosen the 
nits from the hair. This is best done as 
follows: After the hair is dry, a clean fine 
tooth comb should be wet either with vinegar 
or a solution of one teaspoonful of potassium 
carbonate in a pint of water. The hair must 
be separated into fine strands and combed 
carefully. This may have to be repeated 
every day for several days and treatment 
should not be stopped until it is absolutely 
certain that none of the nits remain. 



CHAPTER IX 

ACCIDENTS AND INJURIES 

In every family of young children, numerous 
occasions will arise where emergency treat- 
ment or "first aid" must be given for minor 
injuries or accidents. In the great majority of 
instances, home aid is all that is necessary, 
and with the supplies on hand that are enu- 
merated in the chapter on "The Children's 
Medicine Chest," this aid can be given. It 
is wise to copy, in typewriting if possible, a 
brief outline of the methods to be used in 
dealing with these various emergencies. This 
outline should be pasted on the inner side of 
the door of the medicine closet where it will 
be available at a moment's notice for reference 
when the need is most urgent. 

First Aid 

"First Aid" is a term which refers to the 
immediate help that can be given in any 
emergency. Usually, the minor accidents of 
childhood are not at all serious, although for 
a short time they may be quite painful. 
Nevertheless, there is always the possibility 
that what seems to be a simple injury may 
prove to be a serious one, and for that reason 
the mother should know not only the things 
to be done that will make the patient most 

195 



196 HEALTHY CHILDREN 

comfortable at the time but the kind of first 
aid treatment that may be given that will 
prevent further complications. 

Bruises 

Bumps and bruises are the most common of 
all accidents of childhood. The normal, ac- 
tive child is constantly falling. The ordi- 
nary bump or bruise needs very little atten- 
tion; in fact, it may be safely ignored in the 
majority of instances, and it is unwise to 
attach undue importance to such slight in- 
juries. The normal child will forget all about 
them a few moments after they have occurred, 
and if the skin is not broken and there is no 
danger of infection, the simple bruises and 
bumps may be left untreated. If there is 
marked swelling, however, or if the injury 
has been extensive, it is well to use some 
readily available methods of reducing the 
swelling and preventing the discoloration 
that sometimes comes with a severe bruise. 
For this purpose, cold is the best application. 
It may be applied by wringing out cloths in ice 
water and placing them directly over the 
affected part. They should be changed re- 
peatedly so that the applications may be 
kept ice cold, and such applications should be 
continued for at least half an hour. At the 
end of that time a more permanent dressing 








Method of Applying Strips of Adhesive Plaster 

to Bring Edges of Wound Together. 

See Page 199 for Instructions. 




^ 
g 
^ 
w 



to 










ACCIDENTS AND INJURIES 197 

of a pad of gauze or linen, thoroughly wet 
with witchhazel, may be applied. This should 
be fastened with a bandage so that it may be 
kept in constant contact with the bruise or 
bump. 

Cuts 

Cuts may be made by some sharp instru- 
ment, so that the edges are clean and readily 
come back into contact with each other, or 
they may be jagged, with rough edges and 
more or less dirt may have been rubbed into 
the wound. In order to avoid the possi- 
bility of infection, it is well to allow the cut 
to bleed freely for a moment or two. If the 
blood flows evenly, very little will be lost dur- 
ing this time, and the tendency is for the 
wound to be cleansed in this manner. If the 
blood comes in spurts, it is probable that an 
artery has been severed. In that case the 
blood should not be allowed to continue to 
flow, but should be stopped as soon as pos- 
sible. Long continued bleeding is harmful 
in any case, and definite measures may have 
to be taken to control it. 

The first and easiest measure is to apply 
pressure directly over the bleeding area. The 
edges of the wound should be brought to- 
gether and held firmly. If the bleeding is 
slight, this will usually control it. A pad of 



198 HEALTHY CHILDREN 

gauze placed tightly over a cut will also con- 
trol the bleeding, provided sufficient pressure 
is maintained. If the cut is deep and the 
spurting blood shows that it comes from a 
fairly large artery, pressure should be made 
not only directly over the bleeding part but 
also between the bleeding point and the cen- 
ter of the body. For instance, if the cut is on 
the finger, pressure should be applied by 
winding a stout strip of muslin around the 
finger at its base and holding it very tight for 
a few moments. Bleeding of the forearm can 
be checked by applying a tight bandage, 
called a tourniquet, around the arm between 
the bleeding point and the elbow. A deep 
cut in the upper part of the arm may be con- 
trolled by applying a tourniquet above the 
bleeding point and near the shoulder. The 
same principle applies to controlling bleeding 
in the legs. Bleeding in any part of the head, 
however, or in the trunk of the body, will have 
to be controlled by direct pressure. This is 
always best applied by means of a well- 
folded pad of gauze or clean linen which is 
placed over the wound after the edges have 
been drawn together carefully, and which 
is held in place by a tight bandage or strips of 
adhesive plaster. (See illustration opposite 
page 184.) 



ACCIDENTS AND INJURIES 199 

While it is necessary to stop bleeding as soon 
as possible, it is equally necessary to see that 
the wound is cleansed thoroughly before it 
is closed up. In ordinary cuts or scratches, 
after the wound has been allowed to bleed for 
a moment it should be washed out with clean 
cold water and then with hydrogen peroxide. 
If this is not available, boric acid solution is 
an excellent substitute. A wound of any 
kind must be kept perfectly clean, but unless 
the dressing becomes much soiled, renewed 
washing and cleansing will not be necessary 
within at least twenty-four hours. If the 
bleeding can be controlled and the edges of 
the wound are clean-cut, they may be drawn 
together tightly and held in that position with 
strips of adhesive plaster at right angles to 
the direction of the cut, with several layers of 
gauze placed over it for the purpose of clean- 
liness, and a bandage wound around the entire 
dressing. As soon as the edges of the wound 
begin to heal, it should be kept perfectly dry 
and covered with a little boric acid powder 
which, in turn, is kept in place with a gauze 
or muslin bandage. Cuts or open wounds will 
heal much more quickly under this treatment 
than if ointments are used. (See illustration 
opposite page 196.) 



200 HEALTHY CHILDREN 

Burns 

The important thing to remember about 
burns is that the pain is due mainly to the 
contact of the sore surface with the air, there- 
fore the idea back of the treatment of burns 
is to afford a protective dressing so that the 
air may be excluded. Many household reme- 
dies may be used for burns. Among the most 
common is a mixture of baking soda and water, 
applied as a thick paste. Flour will do, if 
nothing else is available. Unsalted butter 
or lard is excellent. Any perfectly clean, 
unsalted grease will do in an emergency. One 
of the best applications is sweet oil, or, if it is 
available, carron oil can be recommended. 

If the burn has been extensive and serious, 
so that the body is involved, the clothing cov- 
ering it should be cut away and never re- 
moved forcibly. Soaking the burned parts of 
the body in water will make it easier to remove 
pieces of clothing, but care must be taken to 
see that the parts are not injured again. 

After the burned part has been well cov- 
ered with any one of the remedies mentioned, 
a dressing of soft gauze or absorbent cotton 
should be applied, after which it may be 
bandaged lightly. The dressings may be re- 
moved every day, if they are soiled, or every 
two days if there is little secretion, and the 



ACCIDENTS AND INJURIES 201 

burn kept clean in order to avoid infection. 
Dressings which adhere to the wound should 
be soaked off with warm water and the oil 
or other application re-applied. Extensive 
burns are apt to cause serious shock to the 
nervous system, and if there is any general 
prostration following such a burn, the doctor 
should be sent for. In the meantime, the 
patient should be absolutely quiet, and stimu- 
lants such as aromatic spirits of ammonia or 
hot coffee may be given. 

Sprains 

What is called a ' 'sprain' ' usually results 
when some ligament or tendon is subjected to 
undue strain or to some sudden stretching 
or even tearing of its fibers. The most com- 
mon place for a strain to occur is in the ankle, 
then the wrist. Sprains and strains in other 
parts of the body are comparatively infre- 
quent. 

Usually the first sign noted is a sharp pain 
and inability to use the joint that has been 
sprained. Swelling around the point of the 
injury follows very rapidly. Just as soon as 
possible the affected part should be plunged 
into very hot or very cold water, care being 
taken, of course, not to have the water so hot 
as to burn the flesh. Hot water is preferable , 
if it can be obtained, but cold water will have 



202 HEALTHY CHILDREN 

an almost equally good effect, and usually it 
is more readily available. 

While the hand or the foot is held in the 
water, it should be rubbed gently and kneaded 
and the water should be changed at frequent 
intervals so that it may be kept hot or very 
cold. This bathing should be continued for 
at least half an hour. The ankle, wrist or 
other joint that has been sprained should then 
be wiped and placed in such a position that it 
will not be used. It must be kept perfectly 
quiet for at least twenty-four hours, and dur- 
ing that time should be covered with a dress- 
ing wet with either cold water or extract of 
witchhazel. The main thing to remember is 
that the dressing should be kept wet. An easy 
way to apply such a dressing is to cover the 
joint with folds of gauze and wrap a bandage 
loosely around it. The foot or hand should 
be held over a basin and the cold water or 
witchhazel poured over the bandage until it is 
thoroughly wet. This may be repeated when- 
ever the bandage becomes dry, with a mini- 
mum of disturbance both to the patient and 
the dressing. 

One of the best ways to keep the ankle quiet 
is to place the leg between two pillows. At 
the end of twenty-four hours the swelling 
should have subsided to quite an extent. 
Further treatment consists in massaging the 



ACCIDENTS AND INJURIES 203 

joint twice a day. A little oil or vaseline 
may be rubbed on the hand while this is being 
done. 

For slight sprains, the after treatment con- 
sists in bandaging the foot with a strong mus- 
lin bandage or wearing an elastic ankle pro- 
tector, with high laced boots, the purpose 
being to give the ankle support and at the 
same time allow a certain amount of freedom 
of motion. For more severe sprains, it will 
probably be necessary to bandage the ankle 
with adhesive plaster. While this may be 
done after a little practice, it requires a cer- 
tain amount of dexterity. Every mother 
should ask her family physician to teach her 
how to strap or bandage a sprained ankle. 
She may never need this knowledge, but if 
she should at any time, it will be found of 
great value. (See illustration opposite page 
197.) 

The former treatment of sprained joints 
consisted in keeping them perfectly quiet for 
a long period of time. At the present time, 
however, as soon as the swelling has subsided, 
we believe that motion is the best treatment, 
therefore, a reasonable amount of walking 
about may be permitted, provided the ankle 
is well bandaged. The massage should be 
kept up at frequent intervals until the pain, 
tenderness and swelling have disappeared. 



204 HEALTHY CHILDREN 

Strains 

A strain is simply a much lighter form of 
sprain, and should be treated in the same way. 

Broken Bones 

Breaks or fractures in young children are 
not of the same type as those found in adults. 
The bones of very young children contain 
much more animal matter than mineral mat- 
ter, and are more flexible. Breaks, therefore, 
instead of completely severing one part of the 
bone from the other, are in the nature of what 
we call "greenstick" fractures. The differ- 
ence between the two may be illustrated by 
taking a dry stick of wood and breaking it, 
then taking a green twig and breaking that. 
It will be found in the latter case that, while 
the fibers may be drawn apart and injured, 
the pieces of twig are not wholly separated 
from each other. 

Fractures may be of two kinds : The simple 
fracture, where the bone is broken but with- 
out marked injury to the tissue surrounding it, 
and the compound fracture, where the bone 
is broken and fragments of bone have pene- 
trated through the flesh, thus causing both 
a break and a wound. 

The home treatment of fractures of any 
kind, whether greenstick, simple or compound, 



ACCIDENTS AND INJURIES 205 

consists in placing the part at rest until the 
doctor can be summoned and the fractured 
bone set back into its proper relation. In 
order to keep the arm or leg perfectly quiet, 
the patient should be put to bed and the in- 
jured limb placed between two pillows. If 
it is necessary to carry the patient any dis- 
tance, a crude splint may be made by fasten- 
ing a board or even a stick of wood, an um- 
brella or a cane, to the injured limb. This 
stick may be tied on to the leg by fastening a 
handkerchief above and below the point of 
fracture. Its only purpose is to keep the leg 
as nearly motionless as possible. 

It is not possible for an untrained person to 
set a bone, therefore every effort should be 
made to get a doctor at the earliest possible 
moment, as neglected fractures may result 
in serious deformity. 

Nosebleed 

Constant flow of blood from the nose may 
be the result either of an abrasion in the mu- 
cous membrane, which bleeds readily when 
scratched, or it may be the result of a sharp 
blow on the nose. Unless the bleeding per- 
sists for a noticeable length of time, no par- 
ticular treatment is necessary, as it usually 
tends to stop of itself. The child should be 
kept as quiet as possible. Sitting up is a bet- 



206 HEALTHY CHILDREN 

ter position than lying down. The same prin- 
ciple must be applied in stopping a hemor- 
rhage of the nose as has been discussed under 
the heading of treatment of bleeding as a 
result of cuts. A simple way to apply pres- 
sure is to take a piece of stiff paper about one 
inch long and one and a half inches wide. 
This should be folded twice so that there is a 
sharp, folded edge. The paper with this edge 
uppermost should be inserted between the 
upper lip and the gums of the upper teeth, so 
that the sharp edge presses against the blood 
vessel directly in the center, at the point where 
the inside lip joins the top of the gum. The 
sharp edge of the paper should be held there 
so that the pressure against the blood vessel 
is continuous. If the child is kept perfectly 
quiet while this is being done, the bleeding 
will usually stop in about a minute. 

Other methods that have been found valu- 
able are to apply icebags to the back of the 
neck, cold water on the nose itself, or, in the 
absence of any other method, the nostrils 
may be grasped firmly between thumb and 
forefinger and held entirely closed. Packing 
the nose with perfectly clean, sterile gauze 
should be done only in case of great emergency. 
If the bleeding persists, however, notwith- 
standing everything that can be done to stop 
it, such action is justifiable. In order to do 



ACCIDENTS AND INJURIES 207 

this properly, a strip of sterile gauze about 
one inch wide and one yard long should be 
taken. The end of it should be grasped with 
a small pair of forceps and the gauze inserted 
far back into the nostril. The rest of the 
gauze should then be pressed well back into 
the nose, making a firm packing. This must 
be done gently and without undue pressure. 
The reason why the nose should not be packed 
with gauze except in case of extreme emer- 
gency is that it is exceedingly difficult to re- 
move the packing and when it is removed, 
the hemorrhage may return. If the packing 
has been applied, therefore, it should be re- 
moved by a physician. 

After nosebleed, care should be taken to 
see that the child does not blow its nose for 
some time after the bleeding has stopped. If 
the bleeding occurs with fair regularity, and 
in the absence of any accident, it is probable 
that there is some special bleeding point in 
the nose that should receive attention. In 
order to cure it, it will be necessary to take 
the child to a physician and obtain proper 
treatment. 

Insect Bites and Stings 

Children, as well as adults, vary in their 
reaction to bites and stings of insects. Some- 
times the swelling and reaction are quite ex- 



208 HEALTHY CHILDREN 

tensive and the pain may be acute. The main 
danger in insect bites is from the poisoning 
which may result when the stinger of the 
insect is left in the child's flesh or from the 
bite or sting becoming infected afterwards. 
This latter usually results from the itching 
which is common after the bites of certain 
insects and the fact that the child scratches 
the bite and so infects it. 

Usually mosquito bites are treated best by 
applications of spirits of camphor or a moder- 
ately strong solution of ammonia. There- 
after, in the case of children, it is well to see 
that the bites are kept as protected as possible. 
This may be accomplished, if the bites are 
on the legs, by having the child wear long white 
cotton stockings. If mosquitoes are prev- 
alent, long-sleeved, high-necked dresses are 
advised. Every effort should be made to see 
that the child is so cared for that the possi- 
bility of being bitten by mosquitoes is reduced 
to a minimum. Windows should be screened 
and, if necessary, mosquito netting placed over 
the beds and cribs. 

Stings of bees need slightly different treat- 
ment. An attempt should be made to re- 
move the stinger at once. Usually it may 
be seen as a tiny, round black spot, directly 
in the center of the wound. Sometimes it can 
be removed with the fingernails, although oc- 



ACCIDENTS AND INJURIES 209 

casionally the use of a tiny pair of forceps is 
necessary. Immediate relief from the sharp 
pain may be obtained by applying cloths 
dipped in ice water. Cloths wet with a 
solution of boric acid are excellent as pro- 
tective dressings. A solution of ordinary 
baking soda, one tablespoonful to a cup of 
water, can be used. A simple ointment, such 
as zinc oxide ointment, is also an excellent 
remedy. In young children the sting should 
be covered with a protective dressing, so that 
it may not become infected by scratching. 

Foreign Bodies in the Throat 

Very young children are apt to put every- 
thing into their mouths. For that reason 
there should be no loose or detachable parts 
to their toys and they should not be given 
anything to play with that they may put into 
the mouth and swallow. If a foreign body 
is swallowed, the mother should try to remain 
as calm as possible, under circumstances that 
are always distressing. If the child is fright- 
ened and begins to cry, it is probable that the 
foreign body will become more firmly lodged 
in the throat. While action to relieve the 
child should necessarily be quick, there should 
not be any panic. 

First of all, the child should be slapped 
smartlv on the back between the shoulder 



210 HEALTHY CHILDREN 

blades. Frequently this will dislodge the 
foreign body. If not, the child should be 
seized by the legs and held directly upside 
down. At the same time several sharp, quick 
blows should be given with the palm of the 
hand, directly over the back of the child's 
chest. These slaps should be sudden and 
quick, and usually the first one or two will 
dislodge the offending article. Sometimes, 
however, it is necessary for the mother or 
father to put a finger into the child's throat 
to try to dislodge the foreign body. In such 
case, care must be taken not to push it far- 
ther down, but, if possible, to remove it a 
little to one side so that it may be coughed up 
readily. Remember that the tendency is al- 
ways for a child to expel any foreign body that 
is lodged in the larynx or windpipe. If it 
gets into the epiglottis, or tube which carries 
food to the stomach, it usually does not in- 
terfere so much with the child's breathing 
but causes distress because of the feeling of 
pressure in the throat. In such instances the 
article may sometimes be carried down 
through the stomach and intestines if the 
child is fed considerable quantities of soft 
bread or mashed potatoes. This treatment 
is particularly good when a child has swal- 
lowed any sharp thing such as a fish bone or a 
pin. With the soft bread (no crusts) or 



ACCIDENTS AND INJURIES 211 

mashed potatoes the child should drink plenty 
of milk. In this way the article becomes 
covered with a mass of soft food which readily 
passes off through the bowels. If the bowel 
movements are watched carefully, the for- 
eign body will usually be found within two or 
three days. During the time this treatment 
is being carried out, great care must be taken 
to see that no cathartics are used, as they tend 
to liquify the bowel movements and prevent 
the formation of the large soft mass of food 
that will protect the foreign body. 

Foreign Bodies in the Eyes 

Usually these consist of particles of dust, 
and, occasionally, a small insect may be found. 
First, the lower lid should be pulled down, 
and, if the foreign body is seen readily, it may 
be dislodged with the corner of a perfectly 
clean handkerchief. Care should be taken 
that the eyes are not rubbed hard. The child 
should be instructed to blow the nostril on 
the side opposite the injured eye, while the 
other nostril is held tightly closed. If this is 
not successful, rubbing the uninjured eye will 
sometimes cause such a flow of tears that the 
particle may be washed out. The injured 
eye should never be rubbed. 

A simple method of removing particles that 
are under the upper lid is to draw the upper 



212 HEALTHY CHILDREN 

lid well down over the lower one. The eye- 
lashes of the latter then act as a brush to wipe 
off the inner side of the upper lid, and the 
offending particle may often be removed in 
that way. With a little practice, one may 
learn to turn back the upper eyelid over the 
edge of a coin. It is well for the mother to 
ask her doctor to teach her how to do this, as 
often a foreign body that is lodged on the inner 
side of the upper eyelid can be removed in that 
way when it is impossible to do so by any 
other method. 

If, after trying these various methods, the 
foreign body is still felt in the eye, the child 
should be taken to a doctor, as it is possible 
that it may have become imbedded in the 
eyeball, from which it can be removed only by 
a skillful physician. After any foreign body 
has been removed from the eye, the latter 
should be thoroughly flushed out with boric 
acid solution every three hours until all symp- 
toms of inflammation have subsided. 

Foreign Bodies in the Ear 

Usually, the only kind of foreign body that 
gets into the ear is some small insect. The 
treatment in this case is to drop four or five 
drops of sweet oil or castor oil into the ear 
canal. The oil should be slightly warm be- 
fore it is used and may be put into the ear 



ACCIDENTS AND INJURIES 213 

with either a teaspoon or a medicine dropper. 
It should be left for about five minutes, the 
child lying quietly, with the affected ear upper- 
most. At the end of that time the ear should 
be syringed gently with plain warm water and 
a rubber ear syringe. The latter consists of 
a small rubber ball with a short, pointed out- 
let, and can be obtained at any drugstore. 
While syringing the ear, the head should be 
held sideways over a basin so that the water 
will run out freely. No force should be used. 
The oil will kill the insect, and the water will 
cleanse the ear so that the foreign body will 
usually come out with it. 



CHAPTER X 

THE CHILDREN'S MEDICINE CHEST 

A special medicine chest or wall closet 
should be provided where the commoner rem- 
edies and dressings so often needed for chil- 
dren may be kept. 

Type of Medicine Closet 

The best kind of medicine closet is one that 
can be hung on the wall. The suggested di- 
mensions are twenty-four inches in height, 
eighteen inches in width and seven inches in 
depth. The closet should have two shelves 
inserted, so that three spaces may be available. 
A good rule is to have the lower shelf eight 
inches above the bottom of the closet, to pro- 
vide for tall bottles and boxes of dressings. As 
the dimensions given above are outside meas- 
urements, this will leave a total inside space of 
about twenty-one inches. The second shelf 
should be placed about seven inches above 
the first, leaving a space of six inches above 
the second shelf. These heights will be found 
proper for ordinary medicine bottles. 

The cabinet should be provided with a door 
and a good lock, with a hook placed on the 
outside, well up on one side, on which the 
key may be hung. When placing the cabinet 
against the wall, care must be taken to see 

214 



THE CHILDREN'S MEDICINE CHEST 215 

that it is hung high enough so that the children 
cannot reach it. This is important, for little 
children cannot be supposed to show dis- 
cretion, and serious results may follow if they 
obtain the medicines. 

Special Rules for the Medicine Chest 

1. All poisonous substances should be kept in blue bottles of 
distinctive shape. As a general thing, druggists supply 
poisonous substances in bottles of special type. Sometimes 
they have knobs or projections over their surfaces, as well 
as over the surfaces of the corks, which usually are of glass. 
Sometimes they are diamond-shaped to distinguish them from 
the ordinary round or square bottles. Whatever style is 
adopted, it should be one that can be recognized by touch 
as well as by sight so that, even in the dark, there will be no 
possibility of mistaking the bottle that contains an external 
or poisonous remedy for one that may safely be used inter- 
nally. 

2. Bottles which contain medicine that has been prescribed 
by a doctor and only part of which has been used, should 
never be saved. Such medicines are always prescribed for 
a particular illness and for a particular person, and unless 
the doctor states that the medicine will be good for other 
uses, it should be thrown away after the illness is over. Do 
not make the mistake of using for any illness a medicine that 
has been used previously for an illness that may be consid- 
ered similar, unless the doctor especially recommends it. 

3. Before using any medicine taken from the medicine closet, 
the label should be examined carefully. Never trust to 
memory as to the general appearance of a bottle and always 
find out the exact contents before using. 

4. Keep all dressings and utensils on the lower shelf, together 
with any unusually large bottles. On the next shelf keep 
the remedies that are to be used internally, leaving the ex- 
ternal remedies and any poisonous drugs for the top shelf. 

The following articles and dressings are 
recommended. These may vary from time 
to time, to suit the needs of different families 



216 HEALTHY CHILDREN 

but, in general, the list comprises the simple 
remedies and supplies that will meet the needs 
of most of the accidents and simple diseases 
that commonly occur during child life. 

List of Articles Recommended for the Medicine 

Closet 

Teaspoon. 

Medicine glass, marked with teaspoonful and table- 
spoonful doses. 

Clinical thermometer. 

Scissors. 

Package of large safety pins. 

Yard of sterilized gauze, in sealed package. 

Five yard roll of adhesive plaster, one inch wide. 

Small package of absorbent cotton. 

One pound flaxseed meal in airtight box. 

Package of prepared mustard leaves. 

Hot water bottle \ These may be hung on the outside 

Fountain syringe / of the medicine closet. 

One-half pound boric acid powder. 

One-half pound bicarbonate of soda (baking soda). 

One ounce stearate of zinc powder. 

Three ounces of grain alcohol. 

Three ounces of camphorated oil. 

Jar or tube of white vaseline. 

One ounce of zinc oxide ointment. 

Three ounce bottle of witchhazel. 

Three ounces of carron oil (equal parts lime water and 
linseed oil). 

Two ounce bottle aromatic spirits of ammonia. 

Two ounce bottle castor oil. 

One hundred tablets of calomel, each containing one- 
tenth grain. 

Bottle milk of magnesia. 

Two ounces syrup of ipecac. 

Two ounces brown mixture. 

Three ounces rhubarb and soda mixture. 

Two ounces compound licorice powder. 



THE CHILDREN'S MEDICINE CHEST 217 

Flaxseed Poultices 

Although an old-fashioned remedy, flaxseed 
poultices are still one of the best aids we have 
in croup and the common colds that occur 
during childhood. For croup, the poultice 
should be placed around the neck, and for 
colds they should be large enough to cover 
the entire chest. They should be applied as 
hot as they can be borne and allowed to re- 
main only until they become cool. If used 
during the daytime, and if the cold is a serious 
one, the poultices may be renewed two or three 
times. At night they should be taken off be- 
fore the child goes to sleep. As soon as they 
are removed, the chest and neck should be 
rubbed well with alcohol or camphorated oil, 
then covered with a piece of flannel or a layer 
of cotton. 

To make flaxseed poultices, take a pint of 
water and bring it to a brisk boil. Sift flax- 
seed meal gradually into the water, making 
a thick paste. Lay a large oblong piece of 
gauze or old linen on a clean table and spread 
the flaxseed mixture on this to a thickness of 
about one inch, covering an area large enough 
to cover the child's chest or to go around the 
neck. The edges of the gauze or linen should 
then be folded over the poultice, making three 
or four layers in the back, while in front there 



218 HEALTHY CHILDREN 

is only the one layer of linen or possibly two 
of gauze. 

Mustard Leaves 

For more serious colds or for cases of bron- 
chitis or for acute stomach pains, mustard 
leaves are valuable. Usually they come al- 
ready prepared, with accompanying directions. 
They are to be dipped in warm water before 
being applied. Care must be taken to lift 
up the edges of the leaves at frequent inter- 
vals to watch the condition of the skin. The 
leaves should be removed as soon as the skin 
becomes well reddened and before it has had 
a chance to blister. After the plaster is re- 
moved, the skin may be dusted with talcum 
powder or brushed lightly with olive oil, then 
covered with absorbent cotton. 

Boric Acid Powder 

This may be used in the form of a powder, 
as an antiseptic for open wounds, or in the 
form of a solution. The latter has its main 
use as an eyewash or as a mild antiseptic wash 
for burns, cuts or where the skin is broken. 

Boric acid solution is prepared by adding 
one tablespoonful of boric acid powder to one 
pint of water. Boil in a clean dish for five 
minutes, adding water from time to time so 
that the total remains about one pint. Pour 



THE CHILDREN'S MEDICINE CHEST 219 

the solution into an absolutely clean bottle 
that has been thoroughly scoured with hot 
soapsuds and rinsed with boiling water. Keep 
the bottle tightly corked. 

Zinc Oxide Ointment 

This is a good remedy for burns, scratches, 
chafing and various forms of skin diseases, 
including eczema. It should be spread thickly 
on a piece of sterile gauze, then laid over the 
sore. The dressing may be made complete 
by fastening it to the skin with two strips of 
zinc oxide plaster. The edges of the plaster 
should be partly on the gauze and partly on 
the skin, with the ends of the plaster strips 
reaching beyond the gauze so that it may be 
attached firmly to the skin, thus fixing the 
dressing in place. Such a dressing should be 
changed once each day in the early stages of 
the sore. Later, it may be left on for two 
or three days. 

Stearate of Zinc Powder 

This is one of the best dusting powders we 
have for severe chafing, prickly heat, itching 
of the skin or for use on any surface where it is 
desirable to exclude moisture. The powder 
is greasy and will adhere to the skin so that 
the bodily secretions, such as urine, will flow 



220 HEALTHY CHILDREN 

over the surface without causing any skin 
irritation. 

Witchhazel 

Witchhazel is such a common household 
remedy that every family will think of many 
ways in which it can be used. It is excellent 
for sprains of any kind and in cases of bumps 
or bruises. Its best results are obtained when 
it is applied in the form of a wet compress that 
can be bandaged on so that the full value of 
its soothing effects may be secured. 

Canon Oil 

This is probably the best remedy we have 
for burns. It consists of equal parts of lin- 
seed oil and lime water. The mixture does 
not keep well, and, particularly in warm 
weather, it is better to keep the ingredients 
separate and to mix them as needed. It must 
be shaken well so that a thick emulsion is 
formed. This should be spread liberally over 
the burned surface and covered with clean 
gauze. Absorbent cotton should then be 
placed over the gauze so that all air will be 
excluded. 

Aromatic Spirits of Ammonia 

This may be used in any fainting attack 
or in case of severe shock. For children under 



THE CHILDREN'S MEDICINE CHEST 221 

five years of age, not more than one-quarter 
teaspoonful in one-third glassful of water 
should be given. This may be increased 
gradually up to a teaspoonful for a child of 
fifteen years. The dose may be repeated at 
intervals of not more than one-half hour for 
two or three doses. 

Castor Oil 

This universal household remedy should al- 
ways be kept on hand. It keeps well in cold 
weather, but in warm weather the supply 
must be renewed from time to time. At the 
first sign of any digestive disturbance in a 
child, a dose of castor oil should be given and 
all feeding stopped. Nothing but cool boiled 
water should be given for several hours. Later, 
milk and weak broths or cereal gruels may be 
given. 

The dose of castor oil varies slightly with 
the age of the child. The average doses are 
as follows: 

Average Doses of Castor Oil 

Under three months, one teaspoonful. 
Three to six months, two teaspoonfuls. 
Six to twelve months, one tablcspoonful. 

The latter dose will usually be found ade- 
quate for any child up to ten years of age. 
It is best given as follows: 



222 HEALTHY CHILDREN 

The glass should be washed out in very cold 
water. Pour a small portion of orange juice 
into the glass and follow with a layer of castor 
oil. Complete with more of the orange juice. 
If this is done carefully, the orange juice and 
the castor oil will remain in three layers and 
the whole dose can be swallowed without 
tasting the oil. 

In general, castor oil should not be used as 
a regular remedy for constipation. While its 
immediate effect is a loosening of the bowel 
movement, its after-effect is to render the child 
slightly constipated and its constant use tends 
to take away from the bowels their power of 
movement, therefore it should be used only 
in case of an emergency or in acute illness. 

Calomel 

When it is found impossible for the child 
to take castor oil, the next best remedy is 
calomel, followed by some form of saline ca- 
thartic such as citrate of magnesia or epsom 
salts. Calomel may be given in cases of acute 
indigestion or at the beginning of any attack 
of fever, or if there are any symptoms of acute 
illness. The doses of calomel are as follows: 

Doses of Calomel 

For children from two to five years of age, one-tenth 
grain tablet every 15 minutes until 10 tablets have been 
taken (one grain). 



THE CHILDREN'S MEDICINE CHEST 223 

For children from five to ten years of age, one-tenth 
grain tablet every 15 minutes until 15 tablets have been 
taken (1^ grains). 

Calomel should be taken in the late after- 
noon or evening, and next morning the child 
should drink a glassful of citrate of magnesia 
or two teaspoonfuls of epsom salts, dissolved 
in a glass of water. The citrate of magnesia 
tastes like mild lemonade and children take 
it readily. 

Milk of Magnesia 

For young children in particular, milk of 
magnesia has a slightly laxative effect and 
at the same time tends to correct any dis- 
turbed condition of the stomach. The dose 
is one teaspoonful, night and morning. 

Syrup of Ipecac 

This is the best medicine we have for croup. 
It is used to cause vomiting. It may also be 
used if a child has eaten anything that is 
indigestible and it is desired to produce vomit- 
ing in order to empty the stomach of its con- 
tents. For this type of indigestion, one dose 
of a half- teaspoonful is usually sufficient. If 
syrup of ipecac is not available, vomiting may 
be induced by placing one-quarter teaspoonful 
of mustard or one teaspoonful of salt in a glass 
of lukewarm water and forcing the child to 



224 HEALTHY CHILDREN 

drink it. The doses of syrup of ipecac for 
use in cases of croup are as follows: 

Doses of Syrup of Ipecac 

Under 6 months, 15 drops every 10 to 15 minutes. 

6 to 12 months, H to 1 teaspoonful, repeated at 15 
to 30 minute intervals. 

1 to 5 years, 1 teaspoonful at Y% hour intervals. 

5 to 10 years, 1 teaspoonful at 15 minute intervals. 

Unless so ordered by the doctor, not more than three tea- 
spoonfuls should be given. 

Brown Mixture 

This is an excellent cough mixture but 
should not be used for too long a period of 
time, as it contains a small amount of pare- 
goric. It is excellent, however, for use in 
ordinary colds. 

Doses of Brown Mixture 

Under one year, 10 drops. 
1 to 2 years, 15 to 25 drops. 
3 to 5 years, 30 to 40 drops. 
5 years and over, one teaspoonful. 
These doses should be given every three hours. 

Rhubarb and Soda Mixture 

This is one of the best remedies that can 
be prescribed for the slight digestive disturb- 
ances so often encountered in childhood. It 
is best used in liquid form and may be bought 
already prepared at any drugstore. Its use 
corrects slight attacks of indigestion and con- 
trols the formation of gas in the stomach. It 



THE CHILDREN'S MEDICINE CHEST 225 

has a slight laxative effect and may be used 
in mild cases of constipation. 

Doses of Rhubarb and Soda Mixture 

Up to 1 year, }/% teaspoonful. 
1 to 5 years, one teaspoonful. 
The doses noted above should be given after each meal, and 
again at night. 

Compound Licorice Powder 

This is one of the best mild cathartics that 
can be given to children, Its use is not ad- 
vised until a child is about three years old. 

Up to fcve years of age, the dose is one teaspoonful, which 
should be mixed with sufficient water to form a thin paste, then 
added to one-third glassful of cold water. It should be given 
just before bedtime. 






GLOSSARY 

Anus 

Lower termination of the rectum. The opening 

through which the fecal matter is discharged from the 

body. 
Adhesions 

An abnormal joining of one part of the body to another. 
Adhesive Plaster 

Cloth which has been impregnated with some substance 

of a sticky character so that, when applied to the skin, 

it will adhere closely. 

Adolescence 

The period of life between puberty and maturity, from 
about fourteen to twenty-five years in men and twelve 
to twenty-one in women. 



Anemic 
Bacteria 



Bladder 



Cilia 



Deficient in haemoglobin or iron which normally is 
found in the corpuscles or cells of the blood. 

Germs. Bacteria are of many types, each usually 
associated with some special disease, such as the 
bacteria of typhoid, the bacteria of diphtheria, etc. 
Many bacteria are entirely harmless and need be noticed 
only when they occur in larger numbers than thirty 
thousand per cubic centimeter of milk. The bacteria 
which cause disease usually are known as "toxic 
bacteria." 

The organ which holds the urine from the time it leaves 
the kidneys until it passes from the body. A thin sac 
in the front part of the pelvis, just in front of the uterus. 



Fine, hairlike processes or fine hairs such as are found 
in the eyelashes or inside the nostrils. 

Contagion 

The communication of disease by immediate contact or 
by the transmission of bodily discharges. 

Contagious 

Capable of being transmitted from one person to 
another. 

226 



GLOSS A R Y 



Ear Drum 

A membrane of the inner ear which receives sound 
impressions, and from which the impression is trans- 
mitted to the brain. 

Emotion 

Mental excitement. Arousing of the passions or sensi- 
bilities. 

Emotional 

Pertaining to the emotions. 
Enamel 

The white, compact and very hard substance that 
covers and protects the substance of the teeth. 

Environment 

The external surroundings and influences of life. 
Eruption 

Rash. A visible lesion of the skin, due to disease, and 

marked by redness, prominence, or both. 
Forceps 

An instrument with two blades and handles for pulling, 

grasping or compressing. 
Foreskin 

The prepuce. The fold of skin that covers the glans 

or end of the penis in the boy. 
Fracture 

The breaking of a part, especially a bone. 
Function 

The special, normal or proper action of any part or 

organ. 

Genital Organs 

The organs of generation or reproduction. 
Genitals 

Genital Region 

That part of the body which contains the genital 
organs. That part of the body where the genital organs 
are situated. 
Germs 

See bacteria. 



227 



GLOSS AR Y 



Glands 

Organs whose function is to secrete or secure some 
particular fluid from the blood. 

Hypertrophied 

Enlargement or overgrowth of an organ or part. 

Ice-Bag 

A bag, made of waterproof material, filled with ice. 
To be applied to any part of the body. 

Idiosyncrasy 

A habit or quality of body or mind peculiar to any 
individual. 

Immune 

Protected against any particular disease. 

Immunity 

Condition of being immune or protected against any 
particular disease. May be natural, i. e. pertaining to 
the individual, or may be acquired by inoculation. 

Infection 

The communication of disease from one person to 
another. This may be done through body discharges, 
through immediate personal contact or the implanta- 
tion of disease from without, such as infection through 
the air by means of dust particles carrying infection. 

Inoculation 

Injection into the body of a serum or other substance 
to prevent or cure disease. 

Intestines 

The membranous tube that extends from the stomach 
to the rectum. 

Intestinal 

Pertaining to the intestines. 
Larynx 

The organ of voice. The upper part of the trachea or 
windpipe. 

Lesion 

Any hurt, wound or local degeneration. 



228 



GLO SS A R Y 



Malnutrition 

Undernourishment. A condition of the body charac- 
terized by underweight, poorly developed muscles, 
pallor, anemia, bodily fatigue and lack of bodily 
resistance to disease. May be caused by the presence 
of physical defects, insanitary surroundings, lack of 
proper hygienic living conditions, over-excitement, 
wrong kind of feeding, irregular feeding or underfeeding. 

Massage 

Scientific rubbing and manipulation of the body to 
strengthen the tissues and restore tone generally. Acts 
as a mild exercise for the patient. The movements 
are from the extremities toward the heart, and consist 
of kneading, beating, rolling and rubbing movements. 

Mucous Membrane 

Lining of the cavities of the body which connect with 
the external air, as the nose, mouth, etc. 

Nasal Passages 

The nostrils. The openings of the nose, extending back 
to the pharynx. 

Neurasthenia 

Nervous prostration. Depression due to the exhaustion 
of nervous energy. A name for a group of symptoms 
resulting from some functional disorder of the nervous 
system, with severe depression of the vital forces. 

Occlusion 

The act of closing or state of being closed. 



Oral 
Pharynx 



Pertaining to the mouth. 



The cavity in the upper and back part of the throat 
which is between the mouth, the nose and the oesophagus 
or tube leading to the stomach. 

Predisposition 

State of the body rendering it especially liable to 
certain diseases. 

Protective Dressing 

Any dressing that affords protection to any part of the 
body. A dressing which covers a wound, affording 
protection to the injured part. 

229 



GLOSS A R Y 



Pus 

Matter given off from an open sore. The cream-like 

fluid found in abscesses, due to breaking down of the 

tissues. 
Rash 

See eruption. 
Rectum 

The lower end of the large intestine, terminating in the 

anus. 
Tonsils 

Two oval bodies, one on either side of the throat, at 

the opening of the pharynx. 
Tourniquet 

A bandage or instrument, used to exert pressure on an 

artery and so arrest bleeding. 
Undernourishment 

See malnutrition. 
Urine 

The fluid secreted by the kidneys. 
Ventilation 

The supply of fresh air to any enclosed space, as a room. 
Vitality 

The principle of life. 
Vital 

Essential to life; pertaining to life. 



230 



DESIGNED ENGRAVED 

PRINTED 

BUREAU OF ENGRAVING, INC 

MINNEAPOLIS. 

MINN. 



